International Journal of Clinical Pediatric Dentistry

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VOLUME 13 , ISSUE 2 ( March-April, 2020 ) > List of Articles

Original Article

Second Class Functional Treatment: Andreasen Activator vs Twin Block

Giulia Baccaglione, Elisa Rota

Keywords : Andreasen activator, Cephalometrics, II class, Malocclusion, Mandible, Prospective longitudinal clinical study, Twin block

Citation Information : Baccaglione G, Rota E. Second Class Functional Treatment: Andreasen Activator vs Twin Block. Int J Clin Pediatr Dent 2020; 13 (2):144-149.

DOI: 10.5005/jp-journals-10005-1725

License: CC BY-NC 4.0

Published Online: 23-07-2020

Copyright Statement:  Copyright © 2020; The Author(s).


Aim: The purpose of this research is to analyze and compare the dental and skeletal changes induced by two functional devices, Andreasen Activator and Clark's twin block, on the sagittal and vertical plane, by means of cephalometric analysis, of the lateral cephalograms prescribed at the beginning and at the end of the treatment for a second skeletal class, first division with normal or deep bite. Materials and methods: Twenty patients, 8 females and 12 males, fulfilling criteria for inclusion, were divided randomly into two groups: group I was treated with Andreasen activator, the second group with Clark's twin block. The duration of the therapy was about 18 months plus less 2 months. Pretreatment and posttreatment cephalometric radiographs were analyzed using angular (SNA, SNB, ANB, SnaSnp–GoGn angles), linear (Sna–Snp, Co–Gn, Co–Go, Go–Gn) skeletal parameters and dental one (U1–SnaSnp angle, L1–GoGn angle, Overjet and Overbite). To evaluate the posttreatment changes in the single groups and between them, paired and unpaired t-test was used. Results: In both of the two groups analyzed, all the sagittal and vertical, angular and linear, skeletal measurements appear to be increased in a statistically significant way, except SNA angle and the distance Sna–Snp. Regarding the dental parameters, in the group treated with Andreasen activator, only Overjet and Overbite showed statistically significant differences. On the other hand, twin block induced statistical changes about Overjet, Overbite and also U1/SnaSnp, but not about L1/GoGn. The advancement of the mandible determines a greater prominence of the chin and lower lip, an increment of the labial mental angle and a reduction of the convexity of the profile. Also, the decrease of the overjet and, consequently, of the dental exposure improve the esthetic appearance of the patient's face. Conclusion: Both functional treatments showed a lower jaw advanced on the sagittal plane and increased in size. In the upper jaw no significant changes were observed. It was also evident a dental compensation both on sagittal and vertical planes. Clinical significance: The functional devices studied, Andreasen activator and twin block, seem to obtain more skeletal than dental results when the patients were treated at the peak of pubertal growth.

  1. Maddalone M, Ferrari M, Stanizzi A, et al. Use of miniscrew implants in orthodontic distal movement [Utilizzo delle miniviti nelle meccaniche ortodontiche di distalizzazione]. Dent Cadmos 2010;78(8):97–105.
  2. Maddalone M, Ferrari M, Barrila’ S, et al. Intrusive mechanics in orthodontics with the use of TAD's. Dent Cadmos 2010;78(7): 97–106.
  3. Maddalone M. The association between the psychological status and the severity of facial deformity in orthognathic patients. Angle Orthodontist 2012;82(3):396–402. DOI: 10.2319/060211-363.1.
  4. Citterio F, Pellegatta A, Citterio CL, et al. Analysis of the apical constriction using micro-computed tomography and anatomical sections. G Ital Endod 2014;28(1):41–45. DOI: 10.1016/j.gien.2014.05.001.
  5. Venino PM, Citterio CL, Pellegatta A, et al. A micro–computed tomography evaluation of the shaping ability of two nickel-titanium instruments, HyFlex EDM and ProTaper next. J Endod 2017;43(4): 628–632. DOI: 10.1016/j.joen.2016.11.022.
  6. Maddalone M, Gagliani M, Citterio CL, et al. Prevalence of vertical root fractures in teeth planned for apical surgery. A retrospective cohort study. Int Endod J 2018;51(9):969–974. DOI: 10.1111/iej.12910.
  7. Maddalone M, Mirabelli L, Venino PM, et al. Long-term stability of autologous bone graft of intraoral origin after lateral sinus floor elevation with simultaneous implant placement. Clin Implant Dent Relat Res 2018;20(5):713–721. DOI: 10.1111/cid.12649.
  8. Porcaro G, Busa A, Bianco E, et al. Use of a partial-thickness flap for guided bone regeneration in the upper jaw. J Contemp Dent Pract 2017;18(12):1117–1121. DOI: 10.5005/jp-journals-10024-2186.
  9. Franchi L, Baccetti T. Prediction of individual mandibular changes induced by functional jaws orthopedics followed by fixed appliances in class II patients. Angle Orthod 2006;76(6):950–954. DOI: 10.2319/110205-385.
  10. Cozza P, Baccetti T, Franchi L, et al. Mandibular changes produced by functional appliances in class II malocclusion: a systematic review. Am J Orthod Dentofacial Orthop 2006;129(5):599.e1-12. DOI: 10.1016/j.ajodo.2005.11.010.
  11. Chen JY, Will LA, Niederman R. Analysis of efficacy of functional appliances on mandibular growth. Am J Orthod Dentofacial Orthop 2002;122(5):470–476. DOI: 10.1067/mod.2002.126730.
  12. Manjusha KK, Jhothindrakumar K, Nishad A, et al. Growth and development of dentofacial complex influenced by genetic and environmental factors using monozygotic twins. J Contemp Dent Pract 2017;18(9):754–758. DOI: 10.5005/jp-journals-10024-2121.
  13. Hughes T, Bockmann M, Mihailidis S, et al. Genetic, epigenetic, and environmental influences on dentofacial structures and oral health: ongoing studies of australian twins and their families. Twin Research and Human Genetics 2013;16(1):43–51. DOI: 10.1017/thg.2012.78.
  14. Čirgić E, Kjellberg H, Hansen K. Treatment of large overjet in angle class II: division 1 malocclusion with Andresen activators versus prefabricated functional appliances—a multicenter, randomized, controlled trial. Eur J Orthod 2016;38(5):516–524. DOI: 10.1093/ejo/cjv080.
  15. Isiekwe GI, DaCosta OO. Use of twin block of clark in management of angle's class II division I malocclusion. case report. NY State Dent J 2013;79(6):30–34.
  16. Mills CM, McCulloch KJ. Posttreatment changes after successful correction of class II malocclusions with the twin block appliance. Am J Orthod Dentofacial Orthop 2000;118(1):24–33. DOI: 10.1067/mod.2000.104902.
  17. Baccetti T, Franchi L, McNamara JA Jr. An improved version of the cervical vertebral maturation (CVM) method for the assessment of mandibular growth. Angle Orthod 2002;72(4):316–323.
  18. O'Brien K, Wright J, Conboy F, et al. Effectiveness of treatment for class II malocclusion with the herbst or twin-block appliances: a randomized, controlled trial. Am J Orthod Dentofacial Orthop 2003;124(2):128–137. DOI: 10.1016/S0889-5406(03)00345-7.
  19. Bhatia SN, Leighton BC. A manual of facial growth: a computer analysis of longitudinal cephalometric growth data. New York: Oxford University Press; 1993.
  20. Lund DI, Sandler PJ. The effects of twin blocks: a Prospective controlled study. Am J Orthod Dentofacial Orthop 1998;113(1): 104–110. DOI: 10.1016/S0889-5406(98)70282-3.
  21. Tarvade SM, Chaudhari CV, Daokar SG, et al. Dentoskeletal comparison of changes seen in class II cases treated by twin block and Forsus. J Int Oral Health 2014;6(3):27–31.
  22. Tümer N, Gültan AS. Comparison of the effects of monoblock and twin block appliances on the skeletal and dentoalveolar structures. Am J Orthod Dentofacial Orthop 1999;116(4):460–468. DOI: 10.1016/S0889-5406(99)70233-7.
  23. Pavoni C, Cretella Lombardo E, Franchi L, et al. Treatment and post-treatment effects of functional therapy on the sagittal pharyngeal dimensions in class II subjects. Int J Pediatr Otorhinolaryngol 2017;101:47–50. DOI: 10.1016/j.ijporl.2017.07.032.
  24. Stahl F, Baccetti T, McNamara JA Jr. Longitudinal growth changes in untreated subjects with class II division 1 malocclusion. Am J Orthod Dentofacial Orthop 2008;134(1):125–137. DOI: 10.1016/j.ajodo.2006.06.028.
  25. Mills CM, McCulloch KJ. Treatment effects of the twin block appliance: a cephalometric study. Am J Orthod Dentofacial Orthop 1998;114(1):15–24. DOI: 10.1016/S0889-5406(98)70232-X.
  26. Ruf S, Pancherz H. Long term TMJ effects of herbst treatment: a clinical and MRI study. Am J Orthod Dentofacial Orthop 1998;114(5):475–483. DOI: 10.1016/S0889-5406(98)70166-0.
  27. Perinetti G, Primozicc J, Franchi L, et al. Treatment effects of removable functional appliances in pre-pubertal and pubertal class II patients: a systematic review and meta-analysis of controlled studies. PLoS ONE 2015;10(10):e0141198. DOI: 10.1371/journal.pone. 0141198.
  28. O'Brien K, Macfarlane T, Wright J, et al. Early treatment for class II malocclusion and perceived improvements in facial profile. Am J Orthod Dentofacial Orthop 2009;135(5):580–585. DOI: 10.1016/j.ajodo.2008.02.020.
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