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Splinted mandibular protraction appliance.

Jena AK, Singh SP - Contemp Clin Dent (2015)

Bottom Line: In growing patients, forward repositioning of mandible by mandibular repositioning appliances is considered as a treatment of choice.The modified design enhanced the mandibular growth and contributed for the better skeletal correction of Class II malocclusion as compared to the conventional MPAs.This article highlights the design and fabrication of a splinted MPA for the correction of Class II malocclusion due to mandibular retrusion and also describes a patient managed by this appliance.

View Article: PubMed Central - PubMed

Affiliation: Department of Dental Surgery, All India Institute of Medical Sciences, Sijua, Dumduma, Bhubaneswar, Odisha, India.

ABSTRACT
Advancement of mandible rather than tooth movement is an ideal treatment for the correction of Class II malocclusion resulting from mandibular retrusion. In growing patients, forward repositioning of mandible by mandibular repositioning appliances is considered as a treatment of choice. Correction of mandibular retrusion by the conventional mandibular protraction appliances (MPAs) is mainly due to dento-alveolar changes and by altering the design of original MPAs, these limitations were minimized. The modified design enhanced the mandibular growth and contributed for the better skeletal correction of Class II malocclusion as compared to the conventional MPAs. This article highlights the design and fabrication of a splinted MPA for the correction of Class II malocclusion due to mandibular retrusion and also describes a patient managed by this appliance.

No MeSH data available.


Related in: MedlinePlus

Treatment changes by the splinted mandibular protraction appliance (mandibular protraction appliance (MPA). (a) Cephalometric superimposition showing Class I molar and skeletal relationships and improvement of soft tissue harmony and (b) Pitchfork analysis (pretreatment vs. postsplinted MPA-IV)
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Figure 6: Treatment changes by the splinted mandibular protraction appliance (mandibular protraction appliance (MPA). (a) Cephalometric superimposition showing Class I molar and skeletal relationships and improvement of soft tissue harmony and (b) Pitchfork analysis (pretreatment vs. postsplinted MPA-IV)

Mentions: The overall treatment result was very satisfactory. At the end of splinted MPA therapy, Class I molar and skeletal relationships were achieved. The soft tissue harmony was improved significantly [Figure 6a]. The maxillary inter-canine and inter-molar widths were increased by 4 mm each. The correction of Class II skeletal and dental relationship was contributed both by mandibular growth and movement of the maxillary and mandibular dentition. The majority of the molar correction was contributed by the skeletal change whereas the correction of overjet was mainly due to forward movement of the lower incisors and palatal tipping of the maxillary incisors [Figure 6b]. There was total 6.49 mm of molar correction and 9.50 mm of overjet correction by the appliance during the period of 7 months. The skeletal contribution for the molar correction was 61.57% and for the overjet correction was 39.47% [Figure 6b]. However, in contrast to this finding, there was only 38.50% skeletal contribution for the Class II molar and overjet correction by the conventional MPA-IV.[8] The nature of Class II correction by this appliance was similar to the nature of Class II correction by bonded Herbst appliance.[11] The extension of the acrylic splint in the mandibular arch was up to the second premolars. As a result, the molars erupted during the MPA treatment and caused FMA and SN-GoGn to increase by 4° each. However in the subjects with downward and backward rotation of the mandible, the acrylic should be extended up to the last erupted molars to prevent the posterior tooth eruption. The major undesirable effect of functional appliance therapy is forward movement of the lower dentition. In the present case, lower incisors were moved 3 mm forward during the splinted MPA treatment [Figure 6b]. The limited extension of lower acrylic splint up to the second premolars could be responsible for such movement. Although the present case report showed many benefits of splinted MPA over conventional MPAs, but a well-designed case–control study is required to confirm these benefits.


Splinted mandibular protraction appliance.

Jena AK, Singh SP - Contemp Clin Dent (2015)

Treatment changes by the splinted mandibular protraction appliance (mandibular protraction appliance (MPA). (a) Cephalometric superimposition showing Class I molar and skeletal relationships and improvement of soft tissue harmony and (b) Pitchfork analysis (pretreatment vs. postsplinted MPA-IV)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4374311&req=5

Figure 6: Treatment changes by the splinted mandibular protraction appliance (mandibular protraction appliance (MPA). (a) Cephalometric superimposition showing Class I molar and skeletal relationships and improvement of soft tissue harmony and (b) Pitchfork analysis (pretreatment vs. postsplinted MPA-IV)
Mentions: The overall treatment result was very satisfactory. At the end of splinted MPA therapy, Class I molar and skeletal relationships were achieved. The soft tissue harmony was improved significantly [Figure 6a]. The maxillary inter-canine and inter-molar widths were increased by 4 mm each. The correction of Class II skeletal and dental relationship was contributed both by mandibular growth and movement of the maxillary and mandibular dentition. The majority of the molar correction was contributed by the skeletal change whereas the correction of overjet was mainly due to forward movement of the lower incisors and palatal tipping of the maxillary incisors [Figure 6b]. There was total 6.49 mm of molar correction and 9.50 mm of overjet correction by the appliance during the period of 7 months. The skeletal contribution for the molar correction was 61.57% and for the overjet correction was 39.47% [Figure 6b]. However, in contrast to this finding, there was only 38.50% skeletal contribution for the Class II molar and overjet correction by the conventional MPA-IV.[8] The nature of Class II correction by this appliance was similar to the nature of Class II correction by bonded Herbst appliance.[11] The extension of the acrylic splint in the mandibular arch was up to the second premolars. As a result, the molars erupted during the MPA treatment and caused FMA and SN-GoGn to increase by 4° each. However in the subjects with downward and backward rotation of the mandible, the acrylic should be extended up to the last erupted molars to prevent the posterior tooth eruption. The major undesirable effect of functional appliance therapy is forward movement of the lower dentition. In the present case, lower incisors were moved 3 mm forward during the splinted MPA treatment [Figure 6b]. The limited extension of lower acrylic splint up to the second premolars could be responsible for such movement. Although the present case report showed many benefits of splinted MPA over conventional MPAs, but a well-designed case–control study is required to confirm these benefits.

Bottom Line: In growing patients, forward repositioning of mandible by mandibular repositioning appliances is considered as a treatment of choice.The modified design enhanced the mandibular growth and contributed for the better skeletal correction of Class II malocclusion as compared to the conventional MPAs.This article highlights the design and fabrication of a splinted MPA for the correction of Class II malocclusion due to mandibular retrusion and also describes a patient managed by this appliance.

View Article: PubMed Central - PubMed

Affiliation: Department of Dental Surgery, All India Institute of Medical Sciences, Sijua, Dumduma, Bhubaneswar, Odisha, India.

ABSTRACT
Advancement of mandible rather than tooth movement is an ideal treatment for the correction of Class II malocclusion resulting from mandibular retrusion. In growing patients, forward repositioning of mandible by mandibular repositioning appliances is considered as a treatment of choice. Correction of mandibular retrusion by the conventional mandibular protraction appliances (MPAs) is mainly due to dento-alveolar changes and by altering the design of original MPAs, these limitations were minimized. The modified design enhanced the mandibular growth and contributed for the better skeletal correction of Class II malocclusion as compared to the conventional MPAs. This article highlights the design and fabrication of a splinted MPA for the correction of Class II malocclusion due to mandibular retrusion and also describes a patient managed by this appliance.

No MeSH data available.


Related in: MedlinePlus