International Journal of Clinical Pediatric Dentistry

Register      Login

VOLUME 15 , ISSUE 5 ( September-October, 2022 ) > List of Articles


Evaluation of Changes in Soft and Hard Tissues of TMJ among Class II Division 2 Patients after Prefunctional Orthodontics and Twin Block Functional Appliance Therapy: A Prospective MRI Study

Bhumika Patel, Manisha Kamal Kukreja, Ambika Gupta, Seema Rohilla

Keywords : Class II malocclusion, Magnetic resonance imaging, Myofunctional

Citation Information : Patel B, Kukreja MK, Gupta A, Rohilla S. Evaluation of Changes in Soft and Hard Tissues of TMJ among Class II Division 2 Patients after Prefunctional Orthodontics and Twin Block Functional Appliance Therapy: A Prospective MRI Study. Int J Clin Pediatr Dent 2022; 15 (5):479-488.

DOI: 10.5005/jp-journals-10005-2439

License: CC BY-NC 4.0

Published Online: 30-01-2023

Copyright Statement:  Copyright © 2022; The Author(s).


Introduction: No study has been conducted to explore soft and hard tissue changes brought by functional appliances within the temporomandibular joint (TMJ) after correction of class II division 2 (div 2) malocclusion. Hence, we planned this study to evaluate the mandibular condyle disk-fossa relationship before and after prefunctional and twin block therapy using a magnetic resonance imaging (MRI) scan. Methodology: This prospective observational study was conducted among 14 males treated with prefunctional appliances for 3–6 months, followed by 6–9 months of fixed mechanotherapy. MRI scan was evaluated for changes in the TMJ at baseline after completion of prefunctional phase and after completion of functional appliance therapy. Results: At pretreatment, there was a flat contour on the posterosuperior surface of the condyles and a notch-like projection on its anterior surface. After functional appliance therapy, slight convexity appeared on the posterosuperior surface of the condyle and the prominence of the notch was reduced. There was a statistically significant anterior shift of condyles both after prefunctional and twin block treatment. The meniscus on both sides had significantly shifted posteriorly over three stages with respect to the posterior condylar (PC) plane and Frankfort horizontal (FH) plane. The superior joint space had significantly increased with significant linear glenoid fossa displacement between pre and posttreatment stages. Conclusion: Prefunctional orthodontics induced favorable changes in TMJ soft and hard tissues of patients, but they were not sufficient to place the soft and hard tissues in their normal positions. A functional appliance phase is needed to place the TMJ in their respective normal positions.

PDF Share
  1. Arvystas MG. Treatment of severe mandibular retrusion in class II, division 2 malocclusion. Am J Orthod 1979;76(2):149–164. DOI: 10.1016/0002-9416(79)90116-7
  2. Blair ES. A cephalometric roentgenographic appraisal of the skeletal morphology of class I, class II, div. 1, and class II, div. 2 (Angle) malocclusions. Angle Orthod 1954;24(2):106–119. DOI: 10.1043/00033219(1954)024<0106:ACRAOT>2.0.CO;2
  3. Karlsen AT. Craniofacial characteristics in children with Angle class II div. 2 malocclusion combined with extreme deep bite. Angle Orthod 1994;64(2):123–130. DOI: 10.1043/0003-3219(1994)064<0123:CCICWA>2.0.CO;2
  4. O’Ryan F, Epker BN. Temporomandibular joint function and morphology: observations on the spectra of normalcy. Oral Surg Oral Med Oral Pathol 1984;58(3):272–279. DOI: 10.1016/0030-4220(84)90052-5
  5. Katsavrias EG, Halazonetis DJ. Condyle and fossa shape in class II and class III skeletal patterns: a morphometric tomographic study. Am J Orthod Dentofacial Orthop. 2005;128(3):337–346. DOI: 10.1016/j.ajodo.2004.05.024
  6. Fernández Sanromán J, Gómez González JM, del Hoyo JA. Relationship between condylar position, dentofacial deformity and temporomandibular joint dysfunction: an MRI and CT prospective study. J Craniomaxillofac Surg 1998;26(1):35–42. DOI: 10.1016/s1010-5182(98)80033-4
  7. Pullinger AG, Solberg WK, Hollender L, et al. Relationship of mandibular condylar position to dental occlusion factors in an asymptomatic population. Am J Orthod Dentofacial Orthop 1987;91(3):200–206. DOI: 10.1016/0889-5406(87)90447-1
  8. Gianelly AA, Petras JC, Boffa J. Condylar position and class II deep-bite, no-overjet malocclusions. Am J Orthod Dentofacial Orthop 1989;96(5):428–432. DOI: 10.1016/0889-5406(89)90328-4
  9. Al-Saleh MA, Alsufyani N, Flores-Mir C, et al. Changes in temporomandibular joint morphology in class II patients treated with fixed mandibular repositioning and evaluated through 3D imaging: a systematic review. Orthod Craniofac Res 2015;18(4):185–201. DOI: 10.1111/ocr.12099
  10. Kyburz KS, Eliades T, Papageorgiou SN. What effect does functional appliance treatment have on the temporomandibular joint? A systematic review with meta-analysis. Prog Orthod 2019;20(1):32. DOI: 10.1186/s40510-019-0286-9
  11. Xu J, Xu L, Yin Y, et al. Twin block appliance promotes condylar remodeling in patients with class II malocclusion: a systematic review. Res Square 2020. DOI: 10.21203/
  12. Wadhawan N, Kumar S, Kharbanda O, et al. Temporomandibular joint adaptations following two-phase therapy: an MRI study. Orthod Craniofac Res 2008;11(4):235–250. DOI: 10.1111/j.1601-6343.2008.00436.x
  13. Woodside DG. Do functional appliances have an orthopedic effect? Am J Orthod Dentofacial Orthop 1998;113(1):11–14. DOI: 10.1016/S0889-5406(98)70270-7
  14. Nebbe B, Major PW, Prasad NG, et al. Quantitative assessment of temporomandibular joint disk status. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1998;85(5):598–607. DOI: 10.1016/s1079-2104(98)90298-0
  15. Chintakanon K, Sampson W, Wilkinson T, et al. A prospective study of twin-block appliance therapy assessed by magnetic resonance imaging. Am J Orthod Dentofacial Orthoped 2000;118(5):494–504. DOI: 10.1067/mod.2000.109839
  16. Gianelly AA, Hughes HM, Wohlgemuth P, et al. Condylar position and extraction treatment. Am J Orthod Dentofacial Orthop. 1988;93(3):201–205. DOI: 10.1016/s0889-5406(88)80004-0
  17. Demisch A, Ingervall B, Thüer U. Mandibular displacement in Angle class II, division 2 malocclusion. Am J Orthod Dentofacial Orthop 1992;102(6):509–518. DOI: 10.1016/0889-5406(92)70067-K
  18. 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(4):375–388. DOI: 10.1093/ejo/20.4.375
  19. Voudouris JC, Kuftinec MM. Improved clinical use of twin-block and Herbst as a result of radiating viscoelastic tissue forces on the condyle and fossa in treatment and long-term retention: growth relativity. Am J Orthod Dentofacial Orthop 2000;117(3):247–266. DOI: 10.1016/s0889-5406(00)70231-9
  20. Voudouris JC, Woodside DG, Altuna G, et al. Condyle-fossa modifications and muscle interactions during Herbst treatment, part 2. Results and conclusions. Am J Orthod Dentofacial Orthop 2003;124(1):13–29. DOI: 10.1016/s0889-5406(03)00150-1
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.