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Title Mandibular Advancement Appliances Used in Adolescent Orthodontic Treatment for Mandibular Recessive Class II Patients Increase the Pharyngeal Airway
Clinical Question Does the use of a mandibular advancement appliance during orthodontic treatment improve the airway in adolescent patients?
Clinical Bottom Line Clinicians in many dental specialties will interact with adolescent patients who have a recessive mandible and excessive overbite/overjet requiring orthodontic therapy. Evidence appears to indicate an improvement in oral pharyngeal airway space through the use of mandibular advancement appliances. Given these studies, perhaps airway analysis should be considered when there is clinical evidence of an adolescent with a retrusive mandible.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 27729139Celikoglu/201630 patients with skeletal Class II malocclusion due to mandibular retrusionRetrospective Study
Key resultsThe study measured the airway of Herbst patients compared to skeletally anchored Forsus appliance patients. A small sample size was divided into two groups of 15 patients each. Both groups were class II and the only comparison was the different effect on the airway between the two appliances. Oropharyngeal area measurements significantly increased in both groups (Herbst, P < 0.001; Forsus, P < 0.01). There was no statistical differences (P > 0.05) between appliances.
#2) 27641421Manni/201640 patients treated with the Herbst RME combinationRetrospective Study
Key resultsThis retrospective cephalometric study involved two-dimensional airway analysis of patients with Rapid Palatal Expansion (RPE)/Herbst appliances with (subgroup 1) or without (subgroup 2) temporary skeletal temporary anchorage screws (TADs). Both groups had a significant increase in the oropharyngeal airway (p < 0.05). The TAD-anchored subgroup 1 exhibited statistically significant more airway increase than subgroup 2 (p < 0.05), perhaps due to greater skeletal than dental effect. In a study referenced by Kacushi, the change in the skeleton is more important than the change in the teeth.
#3) 25432259Iwasaki/201440 patients; 21 Class II and 19 Class IRetrospective Study
Key resultsThis study compared three dimensional airway changes between two groups of orthodontic patients: 20 Class I patients with normal jaw relationships and routine treatment with braces and 24 Class II patients with a recessive mandible that had treatment with braces and a Herbst appliance. Pretreatment and posttreatment CBCT images were analyzed. The total airway volume (TA) (P< .004), the oropharyngeal volume (OP) (P< .015) and the laryngopharyngeal volume (LP) (P<.021) of the Herbst group were all significantly increased compared to the control group. The authors concluded that “The Herbst appliance enlarged the OP and LP airways. These results may provide a useful assessment of obstructive sleep apnea during growth.”
Evidence Search Herbst[All Fields] AND airway[All Fields]
Comments on
The Evidence
Validity: All three studies showed that mandibular advancement therapy in adolescents significantly improves the pharyngeal airway. The Celikoglu study was a retrospective clinical study comparing two types of mandibular advancement treatment (Herbst versus TAD-anchored Forsus). The Manni retrospective clinical study compared two other different types of mandibular advancement treatment (RPE/Herbst with or without miniscrew anchors). The Iwasaki study was prospective in design and compared orthodontic treatment with Herbst and braces to treatment with braces alone. Although the treatments varied in small ways, all studies demonstrated significant improvements in the oral pharyngeal airway when a mandibular advancement appliance was utilized as part of the treatment. Perspective: Despite the small sample sizes and the varying methods of comparison, evidence suggests that mandibular advancement appliances for the correction of class II malocclusion have merit regarding improved airway dimensions. Further long-term, prospective and randomized controlled studies are needed to assess this treatment approach. It may be advised that three-dimensional airway analysis should be considered in assessing treatment approaches for class II mandibular recessive adolescents.
Applicability Adolescent patients may present for treatment with a recessive mandible resulting in an excess overbite or overjet. A thorough evaluation of the airway in these patients should be performed as part of their diagnosis and treatment planning. Evidence appears to indicate that growing patients treated with a mandibular advancement appliance may have a significantly improved pharyngeal airway. Obstructive Sleep Apnea is a serious health issue. Although there are many contributing factors, treatment during adolescence that takes the airway into account so that it is protected or improved seems prudent.
Specialty/Discipline (Oral Medicine/Pathology/Radiology) (General Dentistry) (Oral Surgery) (Orthodontics) (Pediatric Dentistry)
Keywords Fixed functional treatment; Herbst; Pharyngeal airway; Airway space; Class II treatment; Skeletal anchorage; CBCT
ID# 3186
Date of submission: 04/21/2017spacer
E-mail collinsba@livemail.uthscsa.edu
Author Brent Collins
Co-author(s) e-mail
Faculty mentor/Co-author Ravikumar Anthony, BDS, MDS, MS
Faculty mentor/Co-author e-mail anthonyr@uthscsa.edu
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