Subscribe to RSS
![](/products/assets/desktop/img/oa-logo.png)
DOI: 10.1055/s-0041-1736379
Treatment of Class II Malocclusion With Removable Functional Appliances: A Narrative Review
![](https://www.thieme-connect.de/media/10.1055-s-00051518/202103/lookinside/thumbnails/10-1055-s-0041-1736379_2130001-1.jpg)
Abstract
Around half of all malocclusions that need orthodontic treatment are Class II in nature. Patients with Class II malocclusion primarily seek treatment for aesthetic improvement. Most of the skeletal class II malocclusions are because of mandibular deficiency, and can be best treated during the growing phase of development by removable functional appliances. The objective of this review is to evaluate and compare skeletal and dentoalveolar effects of various removable functional appliances in the treatment of class II malocclusion. Manual and electronic databases were searched, and out of 5,711 articles, 221 abstracts were shortlisted and reviewed. A total of 19 articles that fulfilled the selection criteria was then retrieved and analyzed. A significant increase in mandibular length and dentoalveolar effects with an increase in vertical dimension in a short time was observed with Twin-Block appliance treatment, followed by Bionator appliance treatment. The long-term stability of results achieved with Twin-Block appliance treatment is still questionable. In addition, Frankel appliance treatment effects are more skeletal in nature, with better control in the vertical dimension. However, it takes a more extended treatment duration to produce similar effects. Based on available evidence, we are convinced that removable functional appliances are valuable tools for correction of the Class II malocclusion at a growing age with a horizontal growth pattern.
Keywords
removable functional appliance - twin block - monoblock appliance - Class II malocclusion and occlusal adjustmentPublication History
Article published online:
18 October 2021
© 2021. European Journal of General Dentistry. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India
-
References
- 1 Graber TM, Moss ML, Aronson SL, Enlow DH. Introduction. In: Graber TM, Rakosi T, Petrovic AG. eds. Dentofacial Orthopedics With Functional Appliances. USA: Mosby; 1997
- 2 McNamara Jr JA. Components of class II malocclusion in children 8-10 years of age. Angle Orthod 1981; 51 (03) 177-202
- 3 Martyn TC, Andrew TD. Handbook of Orthodontics. 8th ed.. USA: Mosby; 2010
- 4 Charlier JP, Petrovic A, Herrmann-Stutzmann J. Effects of mandibular hyperpropulsion on the prechondroblastic zone of young rat condyle. Am J Orthod 1969; 55 (01) 71-74
- 5 McNamara Jr JA, Bryan FA. Long-term mandibular adaptations to protrusive function: an experimental study in Macaca mulatta. Am J Orthod Dentofacial Orthop 1987; 92 (02) 98-108
- 6 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 (01) 13-29
- 7 Robert JH, David SC. Regulation of growth in mandibular condylar cartilage. Semin Orthod 2005; 11: 209-218
- 8 Dolce C, McGorray SP, Brazeau L, King GJ, Wheeler TT. Timing of Class II treatment: skeletal changes comparing 1-phase and 2-phase treatment. Am J Orthod Dentofacial Orthop 2007; 132 (04) 481-489
- 9 O'Brien K, Wright J, Conboy F. et al. Effectiveness of early orthodontic treatment with the Twin-block appliance: a multicenter, randomized, controlled trial. Part 2: Psychosocial effects. Am J Orthod Dentofacial Orthop 2003; 124 (05) 488-494 , discussion 494–495
- 10 Tulloch JF, Proffit WR, Phillips C. Outcomes in a 2-phase randomized clinical trial of early Class II treatment. Am J Orthod Dentofacial Orthop 2004; 125 (06) 657-667
- 11 Barton S, Cook PA. Predicting functional appliance treatment outcome in Class II malocclusions–a review. Am J Orthod Dentofacial Orthop 1997; 112 (03) 282-286
- 12 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 Dentofacial Orthop 2006; 130 (05) 594-602
- 13 Mamandras AH, Allen LP. Mandibular response to orthodontic treatment with the Bionator appliance. Am J Orthod Dentofacial Orthop 1990; 97 (02) 113-120
- 14 McNamara Jr JA, Bookstein FL, Shaughnessy TG. Skeletal and dental changes following functional regulator therapy on class II patients. Am J Orthod 1985; 88 (02) 91-110
- 15 Schulhof RJ, Engel GA. Results of Class II functional appliance treatment. J Clin Orthod 1982; 16 (09) 587-599
- 16 Eirew HL. The bionator. Br J Orthod 1981; 8 (01) 33-36
- 17 Macey-Dare LV, Nixon F. Functional appliances: mode of action and clinical use. Dent Update 1999; 26 (06) 240-244 , 246
- 18 O'Brien K, Wright J, Conboy F. et al. Early treatment for Class II Division 1 malocclusion with the Twin-block appliance: a multi-center, randomized, controlled trial. Am J Orthod Dentofacial Orthop 2009; 135 (05) 573-579
- 19 Trenouth MJ. Cephalometric evaluation of the Twin-block appliance in the treatment of Class II Division 1 malocclusion with matched normative growth data. Am J Orthod Dentofacial Orthop 2000; 117 (01) 54-59
- 20 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 (01) 24-33
- 21 Saikoski LZ, Cançado RH, Valarelli FP, de Freitas KM. Dentoskeletal effects of Class II malocclusion treatment with the Twin Block appliance in a Brazilian sample: a prospective study. Dental Press J Orthod 2014; 19 (01) 36-45
- 22 Singh GD, Clark WJ. Localization of mandibular changes in patients with class II division 1 malocclusions treated with twin-block appliances: finite element scaling analysis. Am J Orthod Dentofacial Orthop 2001; 119 (04) 419-425
- 23 Chintakanon K, Sampson W, Wilkinson T, Townsend G. A prospective study of Twin-block appliance therapy assessed by magnetic resonance imaging. Am J Orthod Dentofacial Orthop 2000; 118 (05) 494-504
- 24 Dauravu LM, Vannala V, Arafath M, Singaraju GS, Cherukuri AS, Mathew A. The assessment of sagittal changes with twin block appliance in patients with decelerating growth phase. JCDR Bd 2014; 8 (12) ZC81-ZC84
- 25 Perillo L, Johnston Jr LE, Ferro A. Permanence of skeletal changes after function regulator (FR-2) treatment of patients with retrusive Class II malocclusions. Am J Orthod Dentofacial Orthop 1996; 109 (02) 132-139
- 26 Haynes S. A cephalometric study of mandibular changes in modified function regulator (Fränkel) treatment. Am J Orthod Dentofacial Orthop 1986; 90 (04) 308-320
- 27 Freeman DC, McNamara Jr JA, Baccetti T, Franchi L, Fränkel C. Long-term treatment effects of the FR-2 appliance of Fränkel. Am J Orthod Dentofacial Orthop 2009; 135 (05) 570.e1-570.e6 , discussion 570–571
- 28 Angelieri F, Franchi L, Cevidanes LH, Scanavini MA, McNamara Jr JA. Long-term treatment effects of the FR-2 appliance: a prospective evalution 7 years post-treatment. Eur J Orthod 2014; 36 (02) 192-199
- 29 Cevidanes LH, Franco AA, Scanavini MA, Vigorito JW, Enlow DH, Proffit WR. Clinical outcomes of Fränkel appliance therapy assessed with a counterpart analysis. Am J Orthod Dentofacial Orthop 2003; 123 (04) 379-387
- 30 Weinbach JR, Smith RJ. Cephalometric changes during treatment with the open bite bionator. Am J Orthod Dentofacial Orthop 1992; 101 (04) 367-374
- 31 Toth LR, McNamara Jr JA. Treatment effects produced by the twin-block appliance and the FR-2 appliance of Fränkel compared with an untreated Class II sample. Am J Orthod Dentofacial Orthop 1999; 116 (06) 597-609
- 32 De Almeida MR, Henriques JF, Ursi W. Comparative study of the Fränkel (FR-2) and bionator appliances in the treatment of Class II malocclusion. Am J Orthod Dentofacial Orthop 2002; 121 (05) 458-466
- 33 Dalci O, Altug AT, Memikoglu UT. Treatment effects of a twin-force bite corrector versus an activator in comparison with an untreated Class II sample: a preliminary report. Aust Orthod J 2014; 30 (01) 45-53
- 34 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 (04) 460-468
- 35 Marsico E, Gatto E, Burrascano M, Matarese G, Cordasco G. Effectiveness of orthodontic treatment with functional appliances on mandibular growth in the short term. Am J Orthod Dentofacial Orthop 2011; 139 (01) 24-36
- 36 Vaid NR, Doshi VM, Vandekar MJ. Class II treatment with functional appliances: A meta-analysis of short-term treatment effects. Semin Orthod 2014; 20: 324-338
- 37 Nucera R, Lo Giudice A, Rustico L, Matarese G, Papadopoulos MA, Cordasco G. Effectiveness of orthodontic treatment with functional appliances on maxillary growth in the short term: A systematic review and meta-analysis. Am J Orthod Dentofacial Orthop 2016; 149 (05) 600-611.e3
- 38 Madurantakam P. Removable functional appliances effective in patients with Class II malocclusions. Evid Based Dent 2016; 17 (01) 27-28
- 39 Koretsi V, Zymperdikas VF, Papageorgiou SN, Papadopoulos MA. Treatment effects of removable functional appliances in patients with Class II malocclusion: a systematic review and meta-analysis. Eur J Orthod 2015; 37 (04) 418-434
- 40 Bertl MH, Mandl C, Crismani AG. Do functional orthodontic appliances stimulate mandibular growth in class II division 1 patients. International journal of stomatology & occlusion medicine Bd 2011; 4 (02) 6-28
- 41 Santamaría-Villegas A, Manrique-Hernandez R, Alvarez-Varela E, Restrepo-Serna C. Effect of removable functional appliances on mandibular length in patients with class II with retrognathism: systematic review and meta-analysis. BMC Oral Health 2017; 17 (01) 52