Functional Orthodontic Treatment, Mandibular Retrognathia, Sleep Apnea Syndromes in Children, Upper Airway
Conditions
Keywords
Obstructive sleep apnea, Herbst, Twin Block
Brief summary
Functional appliances are used in the treatment of Class II anomalies caused by mandibular rethrognathia. Herbst which is a fixed and rigid functional appliance and TWB which is removable appliance can be successful in the treatment of mandibular retrognathia in a short period of six to eight months during the pubertal growth phase. An increase in the upper airway size occurs as a result of functional orthopedic treatment devices eliminating the problem of mandibular retrognathia and stimulating mandibular growth. The aim of this randomized controlled trial was to evaluate the effects of TWB and Herbst appliances on sleep quality in children with obstructive sleep apnea. The null hypothesis was that there is no difference for the sleep quality between the appliances.
Detailed description
Introduction: This multicenter clinical study aimed to investigate the effects of twin block (TB) and Herbst functional appliances on sleep quality in children with OSAS and mandibular retrognathia. Methods: A total of 46 patients having mandibular retrognathia and identified with OSA were divided randomly into two groups: twin block (TB) and Herbst functional appliances. Changes in sleep parameters at baseline and an avarage of 8-month follow-up detected by polygraphy and Pittsburg Sleep Quality Index (PSQI) were the primary outcome. Treatment of the mandibular retrognathia was the secondary outcome. hapiro Wilk test and Q-Q graphs were used to examine the distribution assumptions of continuous variables according to groups. Mann Whitney U test was used to evaluate two independent group means or distributions of continuous measurements. Paired sample t test or Wilcoxon signed rank test was used to evaluate the differences between the baseline and follow-up times at p \< 0.05 significance level.
Interventions
PROCEDUREFunctional orthodontic treatment
The patients were treated with Twin block and Herbst functional appliances. Alginate impressions and a protrusive wax bite were taken for the construction of each appliance. Each device was fitted and then reviewed 4-6 weeks later. First group was treated with Twin block which was manufactured basically according to the original design described by Clark. The overjet was measured from the patients in centric relationship and maximum protrusion position, and construction bite was recorded with 70% of the total advancement capacity of the mandible and 2-4 mm above the freeway space vertically. Overjet measurements were made at each session and active treatment was terminated when a normal overjet in the retracted position was recorded. Second group was treated with the stainless-steel crown Herbst appliance, included crowned maxillary first molars and mandibular first premolars. The construction bite was recorded with the mandible forward by edge-to-edge incisor position.
Sponsors
Gökçenur Gökçe Kara
Izmir Katip Celebi University
Ege University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Outcomes Assessor)
Masking description
Double (Participant, Outcomes Assessor)
Intervention model description
2-arm parallel trial
Eligibility
Sex/Gender
ALL
Age
11 Years to 15 Years
Healthy volunteers
No
Inclusion criteria
* no prior orthodontic treatment, nasal, tonsillar, or adenoid surgery * absence of any oral, nasal or systemic disease * the existence of skeletal Class II and dental Class II Division 1 malocclusion (ANB \>4°; SNB \<80°; incisor overjet \>3 mm) * requiring functional orthodontic treatment * Individuals are in the MP3cap and S period according to hand-wrist films, and in the CS3 and CS4 period using the CVM method * patients with OSA (apnea/hypopnea index (AHI)\>1/h
Exclusion criteria
* body mass index (BMI) ≥ 30 (weight (kg)/height (m2)) * the presence of nasopharyngeal pathologies, craniofacial anomalies, , systemic disorder, or weak oral hygiene * history of previous orthodontic treatment
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Correction of mandibular retrognathia | Following 6-8 months active treatment | A normal or corrected overjet in the retracted position |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Polygraphic assessment of sleep parameters | Following 6-8 months active treatment | Changes in apnea hypopnea index (AHI) |
Countries
Turkey (Türkiye)
Outcome results
None listed