The Effectiveness Of Early Treatment For Class ? Malocclusion With Twin-block

BackgroundClass ? malocclusion is one of the most common malocclusion in the orthodontic field,according to angles classification,this malocclusion occurs when the mesiobuccal cusp of the upper first molar is not aligned with the mesiobuccal groove of the lower first molar.Class ? malocclusion can categorize into two subtypes which are class ?division 1 and class ? division 2.The main factors that cause class ? malocclusion can be divided into three factors;skeletal factors,muscle factors and dental factors,other factors can also be associated with this malocclusion like habits.The treatment of this malocclusion is depending on severity,growth prospective and timing.Early treatment of this malocclusion is the best choice because it can Result in less damage to the teeth and surrounding tissues.Early treatment of this malocclusion involves the use of functional appliances and can be either with two-phase or one-phase therapy.Obstructive Sleep Apnea Hypopnea Syndrome(OSAHS)can be associated with the class ? malocclusion because the mandibular deficiency can reduce the space present between the cervical column and the mandibular body which may lead to posterior positioning of the tongue and soft palate causing narrowing in the oropharyngeal airway dimension.Therefore we investigate the effect of the Twin block appliance on the upper airway.Aim/hypothesisThe current study was undertaken with an aim to investigate the effect of early treatment with the use of twin block appliance on class ? malocclusion patient and suffering from(OSAHS).Materials and methods1.we chose the patient that having a class ? malocclusion ANB>5 degree and suffering from(OSAHS)believed to be as a result of the class ? malocclusion.2.Cephalometrics analysis;lateral cephalogram was performed on sagittal X-ray to investigate the dental and skeletal changes before and after the treatment.3.Airway dimensions analysis;lateral cephalogram was performed on sagittal X-ray to investigate the effect of the treatment on the upper airway dimensions before and after the treatment.Case reportPresent history:A 13 years old male patient was admitted to the department of orthodontist in the dental hospital with chief complaint of upper teeth forwardly placed and misalignment of the teeth.The patient was diagnosed with class ? malocclusion with an increased overjet.And when we analyzed the patient X-ray the upper airway was narrow,and then when the parents were asked about sleeping quality we found that the patient was suffering from serious sleep disorder believed to be as a symptom of Obstructive Sleep Apnea Hypopnea Syndrome(OSAHS).Treatment After the patient was fully diagnosed,the patient was evaluated as class? division 1 skeletal malocclusion with retro/micrognathism of the mandible.And the patient had considerable level of growth remaining,according to that we decided to treat the patent with the two-phase therapy,phase-one therapy with the removable twin block appliance and then phase-two with a fixed appliance.Results Class II division 1with the use of Twin block was successfully treated by the correction of the molar relationship,overjet,overbite,incisor alignment,and growth enhancement of the mandible.In addition,a significant increasing in nasopharynx,oropharynx,and hypopharynx sagittal dimensions was achieved by the use of twin block appliance.Conclusions1.Early treatment of skeletal class II class II division 1 with the functional appliance Twin block has a clinically significant correction of the molar relationship,overjet,overbite,incisor alignment,and growth enhancement of the mandible2.Early treatment with the use of the functional appliance Twin block leads to an increase in nasopharynx,oropharynx,and hypopharynx sagittal dimensions which can help in avoiding problems that associated with small airway during the growth such as(mouth breathing,bruxism and OSAHS),But further studies are needed.