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Effects of Two Appliances Used in the Correction of Class II Malocclusion on Mandibular Symphysis Morphology: Biblock and Activator

Yıl 2025, Cilt: 35 Sayı: 4, 300 - 306, 21.10.2025
https://doi.org/10.17567/currresdentsci.1452172

Öz

Objective: This study aimed to evaluate and compare the effects of two functional appliances, the Activator (AA) and the Biblock (BA), on mandibular symphysis (MS) morphology in patients with Class II malocclusion.
Methods: Records of patients treated at the Department of Orthodontics, Ankara University, between 2011 and 2021 were retrospectively analyzed. Inclusion criteria were mandibular deficiency, optimal growth pattern, and CS2–CS3 cervical maturation stage. Twenty patients treated with the Biblock (10 females, 10 males; mean age: 13.52±1.36 years) were identified. An age- and sex-matched control group of 20 patients treated with the Activator (mean age: 13.78±1.18 years) was selected. Lateral cephalometric radiographs taken before and after treatment were evaluated for angular and linear changes. Intragroup comparisons were performed with paired t-tests, and intergroup comparisons with independent t-tests.
Results: The mean treatment duration was 17.39±5.94 months in the BA group and 17.03±4.37 months in the AA group. Both appliances significantly improved Class II malocclusion. Significant anterior MS changes were observed in both groups, except for B-Ida-Idp. Upper MS width remained unchanged, while significant increases occurred in the middle (AA: 0.4±0.5 mm; BA: 0.4±0.5 mm) and lower widths (AA: 0.9±0.2 mm; BA: 0.8 ± 0.7 mm) (P<.005). Intergroup comparisons showed greater reduction in Pg-B-Ida and greater increase in Pg-B in the BA group (P<.05).
Conclusion: Functional treatment flattened MS curvature, promoted forward growth of B and Pg points, and altered anterior MS morphology. The effects of AA and BA on MS morphology were largely similar.
Keywords: Class II malocclusion, Functional appliance, Biblock, Activator, Mandibular symphysis morphology

Kaynakça

  • 1. Varlik SK, Gultan A, Tumer N. Comparison of the effects of Twin Block and activator treatment on the soft tissue profile. Eur J Orthod. 2008;30(2):128-134. doi:10.1093/ejo/cjm121
  • 2. Rota E, Baccaglione G. 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
  • 3. Cozza P. Dentoskeletal effects and facial profile changes during activator therapy. Eur J Orthod. 2004;26(3):293-302. doi:10.1093/ejo/26.3.293
  • 4. Khan MI, Neela PK, Unnisa N, Jaiswal AK, Ahmed N, Purkayastha A. Dentoskeletal effects of Twin Block appliance in patients with Class II malocclusion. Medicine and Pharmacy Reports. Published online October 15, 2021. doi:10.15386/mpr-1989
  • 5. Cozza P, Baccetti T, Franchi L, De Toffol L, McNamara JA. Mandibular changes produced by functional appliances in Class II malocclusion: A systematic review. Am J Orthod Dent Orthop. 2006;129(5):599.e1-599.e12. doi:10.1016/j.ajodo.2005.11.010
  • 6. Sherwood RJ, Hlusko LJ, Duren DL, Emch VC, Walker A. Mandibular Symphysis of Large-Bodied Hominoids. Human Biol. 2005;77(6):735-759. doi:10.1353/hub.2006.0020
  • 7. Gracco A, Luca L, Bongiorno MC, Siciliani G. Computed tomography evaluation of mandibular incisor bony support in untreated patients. Am J Orthod Dent Orthoped. 2010;138(2):179-187. doi:10.1016/j.ajodo.2008.09.030
  • 8. Swasty D, Lee J, Huang JC, et al. Cross-sectional human mandibular morphology as assessed in vivo by cone-beam computed tomography in patients with different vertical facial dimensions. Am J Orthod Dent Orthop. 2011;139(4):e377-e389. doi:10.1016/j.ajodo.2009.10.039
  • 9. Al-Khateeb SN, Maaitah EFA, Alhaija ESA, Badran SA. Mandibular symphysis morphology and dimensions in different anteroposterior jaw relationships. Angle Orthod. 2013;84(2):304-309. doi:10.2319/030513-185.1
  • 10. Wehrbein H, Bauer W, Diedrich P. Mandibular incisors, alveolar bone, and symphysis afterorthodontic treatment. A retrospective study. Am J Orthod Dent Orthop. 1996;110(3):239-246. doi:10.1016/s0889-5406(96)80006-0
  • 11. Johal A, Katsaros C, Kiliaridis S, et al. State of the science on controversial topics: orthodontic therapy and gingival recession (a report of the Angle Society of Europe 2013 meeting). Progress Orthod. 2013;14(1). doi:10.1186/2196-1042-14-16
  • 12. Jain S, Puniyani P, Saifee A. Mandibular symphysis morphology and lower incisor angulation in different anteroposterior jaw relationships and skeletal growth patterns – a cephalometric study. Med Pharmacy Rep. 2020;93(1):97-104. doi:10.15386/mpr-1356
  • 13. Nobre R, De Castro SM, Ponces MJ, Lopes JD, Ferreira AP. The relation between mandibular symphysis and the Angle class in orthodontic treatment. Med Pharm Rep. 2022;95(4):446-454. doi:10.15386/mpr-2416
  • 14. Steiner CC. Cephalometrics for you and me. Am J Orthod. 1953;39(10):729-755. doi:10.1016/0002-9416(53)90082-7
  • 15. Baccetti T, Franchi L, McNamara JA. The Cervical Vertebral Maturation (CVM) method for the assessment of optimal treatment timing in dentofacial orthopedics. Seminars Orthod. 2005;11(3):119-129. doi:10.1053/j.sodo.2005.04.005
  • 16. Jena AK, Duggal R, Parkash H. Skeletal and dentoalveolar effects of Twin-block and bionator appliances in the treatment of Class II malocclusion: A comparative study. Am J Orthod Dent Orthop. 2006;130(5):594-602. doi:10.1016/j.ajodo.2005.02.025
  • 17. Hoang N, Nelson G, Hatcher D, Oberoi S. Evaluation of mandibular anterior alveolus in different skeletal patterns. Progress Orthod. 2016;17(1). doi:10.1186/s40510-016-0135-z
  • 18. Bilgiç F, Başaran G, Hamamci O. Comparison of Forsus FRD EZ and Andresen activator in the treatment of class II, division 1 malocclusions. Clin Oral Invest. 2014;19(2):445-451. doi:10.1007/s00784-014-1237-y
  • 19. Türkkahraman H, Sayın MÖ. Effects of activator and activator headgear treatment: comparison with untreated Class II subjects. Eur J Orthod. 2005;28(1):27-34. doi:10.1093/ejo/cji062
  • 20. Tümer N, Gültan AS. Comparison of the effects of monoblock and twin-block appliances on the skeletal and dentoalveolar structures. Am J Orthod Dent Orthop. 1999;116(4):460-468. doi:10.1016/s0889-5406(99)70233-7
  • 21. Xie J, Huang C, Yin K, Park J, Xu Y. Effects of orthodontic treatment with activator appliance on patients with skeletal Class II malocclusion: a systematic review and meta-analysis. Annals Palliative Med. 2021;10(12):12319-12334. doi:10.21037/apm-21-3205
  • 22. Basciftci FA. The effects of activator treatment on the craniofacial structures of Class II division 1 patients. Eur J Orthod. 2003;25(1):87-93. doi:10.1093/ejo/25.1.87
  • 23. Kirtane RS, Wiltshire WA, Thiruvenkatachari B, Shah A, Santos PBDD, De Sa Leitao Pinheiro FH. Cephalometric effects of Twin-block and van Beek Headgear-Activator in the correction of Class II malocclusion. Am J Orthod Dent Orthop. 2023;163(5):677-689. doi:10.1016/j.ajodo.2022.05.020
  • 24. Dikmen F, Ağlarcı C. Twin-Blok Apareyi. Atatürk Üniv Diş Hek Fak Derg. 2015;25:132-139. doi:10.17567/dfd.08715
  • 25. Kılıç N, Erdem A, Tunç S. Changes in the dentofacial morphology between class II patients treated with one of the two treatment modalities: functional appliance and headgear. A retrospective cephalometric study. Atatürk Üniv Diş Hek Fak Derg. 2021;31(4):500-506. doi:10.17567/ataunidfd.977613
  • 26. Buschang PH, Julien K, Sachdeva R, Demirjian A. Childhood and pubertal growth changes of the human symphysis. Angle Orthodontist. 1992;62(3):203-210. doi:10.1043/0003-3219(1992)062<0203:CAPGCO>2.0.CO;2
  • 27. Ruiz F, Venezia P, Ronsivalle V, et al. Geometric Morphometric Analysis of Mandibular Symphysis Growth between 12 and 15 Years of Age in Class II Malocclusion Subjects. Life. 2023;13(2):543. doi:10.3390/life13020543

Sınıf II Maloklüzyonun Düzeltilmesinde Kullanılan İki Apareyin Mandibular Simfiz Morfolojisi Üzerindeki Etkileri: Biblok ve Aktivatör

Yıl 2025, Cilt: 35 Sayı: 4, 300 - 306, 21.10.2025
https://doi.org/10.17567/currresdentsci.1452172

Öz

Amaç: Amaç: Bu çalışmanın amacı, Sınıf II maloklüzyonları tedavi etmek için kullanılan iki fonksiyonel aparey olan Aktivatör (AA) ve Biblok'un (BA) mandibular simfiz (MS) morfolojisi üzerindeki etkilerini araştırmak ve karşılaştırmaktır.
Yöntemler: Mandibular retrognati ve optimum büyüme paterninden kaynaklanan iskeletsel Sınıf 2 maloklüzyonu olan 40 hasta bu retrospektif çalışmaya dahil edildi. BA grubunun seçilmesinin ardından (n=20, 10 erkek ve 10 kız, ortalama yaş=13,52±1,36), cinsiyet ve gelişim açısından bu grupla tam olarak eşleşen AA ile tedavi edilen aktif kontrol grubu (n=20, 10 erkek ve 10 kız, ortalama yaş=13,78±1,18) seçildi. Tüm hastalar T0'da CS2-CS3 servikal matürasyon aşamasındaydı. İskeletsel, dental ve MS ile ilgili sefalometrik değişkenler ölçüldü. Bulgular: Tedavi süresi BA ile 17,39±5,94 ay, AA ile 17,03±4,37 ay olarak bulundu. Sınıf II maloklüzyon her iki grupta da anlamlı olarak düzeldi. Her iki grupta da B-Ida-Idp hariç, MS'in anterior ölçümlerinde anlamlı değişiklikler vardı. Her iki grupta da üst MS genişliğinde değişiklik olmazken, orta genişlikte (AA:0,4±0,5 mm; BA:0,4±0,5 mm) ve alt genişlikte (AA:0,9±0,2 mm; BA:0,8±0,7 mm) anlamlı artış gözlendi (P<,005). Gruplar karşılaştırıldığında, Pg-B-Ida'daki azalma ve Pg-B'deki artış BA grubunda anlamlı olarak daha fazlaydı (P<,05).
Sonuç: Fonksiyonel tedavi ile MS eğriliği düzleşti, B ve Pg noktaları öne doğru büyüdü ve MS'nin ön morfolojisi değişti. AA ve BA'nın MS morfolojisi üzerindeki etkileri benzerdir.
Anahtar Kelimeler: Sınıf II maloklüzyon, Fonksiyonel aparey, Biblock, Aktivatör, Mandibular simfiz morfolojisi

Kaynakça

  • 1. Varlik SK, Gultan A, Tumer N. Comparison of the effects of Twin Block and activator treatment on the soft tissue profile. Eur J Orthod. 2008;30(2):128-134. doi:10.1093/ejo/cjm121
  • 2. Rota E, Baccaglione G. 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
  • 3. Cozza P. Dentoskeletal effects and facial profile changes during activator therapy. Eur J Orthod. 2004;26(3):293-302. doi:10.1093/ejo/26.3.293
  • 4. Khan MI, Neela PK, Unnisa N, Jaiswal AK, Ahmed N, Purkayastha A. Dentoskeletal effects of Twin Block appliance in patients with Class II malocclusion. Medicine and Pharmacy Reports. Published online October 15, 2021. doi:10.15386/mpr-1989
  • 5. Cozza P, Baccetti T, Franchi L, De Toffol L, McNamara JA. Mandibular changes produced by functional appliances in Class II malocclusion: A systematic review. Am J Orthod Dent Orthop. 2006;129(5):599.e1-599.e12. doi:10.1016/j.ajodo.2005.11.010
  • 6. Sherwood RJ, Hlusko LJ, Duren DL, Emch VC, Walker A. Mandibular Symphysis of Large-Bodied Hominoids. Human Biol. 2005;77(6):735-759. doi:10.1353/hub.2006.0020
  • 7. Gracco A, Luca L, Bongiorno MC, Siciliani G. Computed tomography evaluation of mandibular incisor bony support in untreated patients. Am J Orthod Dent Orthoped. 2010;138(2):179-187. doi:10.1016/j.ajodo.2008.09.030
  • 8. Swasty D, Lee J, Huang JC, et al. Cross-sectional human mandibular morphology as assessed in vivo by cone-beam computed tomography in patients with different vertical facial dimensions. Am J Orthod Dent Orthop. 2011;139(4):e377-e389. doi:10.1016/j.ajodo.2009.10.039
  • 9. Al-Khateeb SN, Maaitah EFA, Alhaija ESA, Badran SA. Mandibular symphysis morphology and dimensions in different anteroposterior jaw relationships. Angle Orthod. 2013;84(2):304-309. doi:10.2319/030513-185.1
  • 10. Wehrbein H, Bauer W, Diedrich P. Mandibular incisors, alveolar bone, and symphysis afterorthodontic treatment. A retrospective study. Am J Orthod Dent Orthop. 1996;110(3):239-246. doi:10.1016/s0889-5406(96)80006-0
  • 11. Johal A, Katsaros C, Kiliaridis S, et al. State of the science on controversial topics: orthodontic therapy and gingival recession (a report of the Angle Society of Europe 2013 meeting). Progress Orthod. 2013;14(1). doi:10.1186/2196-1042-14-16
  • 12. Jain S, Puniyani P, Saifee A. Mandibular symphysis morphology and lower incisor angulation in different anteroposterior jaw relationships and skeletal growth patterns – a cephalometric study. Med Pharmacy Rep. 2020;93(1):97-104. doi:10.15386/mpr-1356
  • 13. Nobre R, De Castro SM, Ponces MJ, Lopes JD, Ferreira AP. The relation between mandibular symphysis and the Angle class in orthodontic treatment. Med Pharm Rep. 2022;95(4):446-454. doi:10.15386/mpr-2416
  • 14. Steiner CC. Cephalometrics for you and me. Am J Orthod. 1953;39(10):729-755. doi:10.1016/0002-9416(53)90082-7
  • 15. Baccetti T, Franchi L, McNamara JA. The Cervical Vertebral Maturation (CVM) method for the assessment of optimal treatment timing in dentofacial orthopedics. Seminars Orthod. 2005;11(3):119-129. doi:10.1053/j.sodo.2005.04.005
  • 16. Jena AK, Duggal R, Parkash H. Skeletal and dentoalveolar effects of Twin-block and bionator appliances in the treatment of Class II malocclusion: A comparative study. Am J Orthod Dent Orthop. 2006;130(5):594-602. doi:10.1016/j.ajodo.2005.02.025
  • 17. Hoang N, Nelson G, Hatcher D, Oberoi S. Evaluation of mandibular anterior alveolus in different skeletal patterns. Progress Orthod. 2016;17(1). doi:10.1186/s40510-016-0135-z
  • 18. Bilgiç F, Başaran G, Hamamci O. Comparison of Forsus FRD EZ and Andresen activator in the treatment of class II, division 1 malocclusions. Clin Oral Invest. 2014;19(2):445-451. doi:10.1007/s00784-014-1237-y
  • 19. Türkkahraman H, Sayın MÖ. Effects of activator and activator headgear treatment: comparison with untreated Class II subjects. Eur J Orthod. 2005;28(1):27-34. doi:10.1093/ejo/cji062
  • 20. Tümer N, Gültan AS. Comparison of the effects of monoblock and twin-block appliances on the skeletal and dentoalveolar structures. Am J Orthod Dent Orthop. 1999;116(4):460-468. doi:10.1016/s0889-5406(99)70233-7
  • 21. Xie J, Huang C, Yin K, Park J, Xu Y. Effects of orthodontic treatment with activator appliance on patients with skeletal Class II malocclusion: a systematic review and meta-analysis. Annals Palliative Med. 2021;10(12):12319-12334. doi:10.21037/apm-21-3205
  • 22. Basciftci FA. The effects of activator treatment on the craniofacial structures of Class II division 1 patients. Eur J Orthod. 2003;25(1):87-93. doi:10.1093/ejo/25.1.87
  • 23. Kirtane RS, Wiltshire WA, Thiruvenkatachari B, Shah A, Santos PBDD, De Sa Leitao Pinheiro FH. Cephalometric effects of Twin-block and van Beek Headgear-Activator in the correction of Class II malocclusion. Am J Orthod Dent Orthop. 2023;163(5):677-689. doi:10.1016/j.ajodo.2022.05.020
  • 24. Dikmen F, Ağlarcı C. Twin-Blok Apareyi. Atatürk Üniv Diş Hek Fak Derg. 2015;25:132-139. doi:10.17567/dfd.08715
  • 25. Kılıç N, Erdem A, Tunç S. Changes in the dentofacial morphology between class II patients treated with one of the two treatment modalities: functional appliance and headgear. A retrospective cephalometric study. Atatürk Üniv Diş Hek Fak Derg. 2021;31(4):500-506. doi:10.17567/ataunidfd.977613
  • 26. Buschang PH, Julien K, Sachdeva R, Demirjian A. Childhood and pubertal growth changes of the human symphysis. Angle Orthodontist. 1992;62(3):203-210. doi:10.1043/0003-3219(1992)062<0203:CAPGCO>2.0.CO;2
  • 27. Ruiz F, Venezia P, Ronsivalle V, et al. Geometric Morphometric Analysis of Mandibular Symphysis Growth between 12 and 15 Years of Age in Class II Malocclusion Subjects. Life. 2023;13(2):543. doi:10.3390/life13020543
Toplam 27 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Ortodonti ve Dentofasiyal Ortopedi
Bölüm Araştırma Makalesi
Yazarlar

Berrak Çakmak 0000-0003-4664-092X

Meliha Rübendiz 0000-0001-6069-0101

Yayımlanma Tarihi 21 Ekim 2025
Gönderilme Tarihi 15 Mart 2024
Kabul Tarihi 10 Temmuz 2024
Yayımlandığı Sayı Yıl 2025 Cilt: 35 Sayı: 4

Kaynak Göster

AMA Çakmak B, Rübendiz M. Effects of Two Appliances Used in the Correction of Class II Malocclusion on Mandibular Symphysis Morphology: Biblock and Activator. Curr Res Dent Sci. Ekim 2025;35(4):300-306. doi:10.17567/currresdentsci.1452172

Current Research in Dental Sciences is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

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