ORTHODONTICS
Cite this article:
Showkatbakhsh R, Jamilian
A, Alipanahi M, Perillo L.
Treatment Effects of RAppliance in Vertical Growing Patients-Case Series.
Stoma Edu J. 2014;1(2):
102-107.
TREATMENT EFFECTS
OF R-APPLIANCE IN VERTICAL
GROWING PATIENTS-CASE SERIES
Rahman Showkatbakhsh1a,
Abdolreza Jamilian2a*,
Minoo Alipanahi2b,
Letizia Perillo3c
1. Department of Orthodontics, Shahid Beheshti
University of Medical Sciences, Tehran, Iran
2. Department of Orthodontics,
Tehran Dental Branch, Craniomaxillofacial
Center Islamic Azad University, Tehran, Iran
3. Departments of Orthodontics, Second
University of Naples, Naples, Italy
a. DDS, PhD, Associate Professor
b. DDS
c. DDS, PhD, Professor
Abstract
The purpose of this study was to evaluate the effects of a functional appliance
(the R-appliance) on Class II division I vertical growth pattern patients with
mandibular deficiency. Twenty patients (13 girls and 7 boys) of an average age
of 10.6 (SD 0.8) years were treated with R-appliance for 16 (SD 0.4) months.
All patients had Class II division 1 malocclusions due to mandibular deficiency
and were vertical growers. Lateral cephalograms obtained at the beginning
(T1) and at the end (T2) of the study were analyzed. Paired t-tests showed that
SNB significantly increased from 72.8° (SD 2.2°) to 76° (SD 1.8°) (P<0.001) after
treatment. The incisor mandibular plane angle (IMPA) significantly decreased
and the Jarabak index increased for 1.7% (SD 2.5%) (P<0.007). R-appliance was
successful in moving the mandible forward in vertical growth pattern patients
without proclination of the lower incisors.
Keywords: Functional Appliance, Class II Division 1, mandibular deficiency,
R-appliance, vertical growth pattern
Introduction
Class II division 1 malocclusion due to mandibular deficiency is a commonly
observed clinical problem (1, 2), and it has been extensively studied for skeletal and
dental characteristics (3, 4). Different functional appliances have been used to treat this
malocclusion (5-13). Functional appliances put the mandible in forward position, result
in stretches on the related attached muscular groups of the mandible, and create bone
remodeling and muscular adaptation (14-21). However, it is reported in the literature that
functional appliances can cause restriction of maxillary growth (5, 22, 23). Moreover, flaring
of lower incisors is another of their disadvantages (24, 25). The influence of functional
appliances in the vertical relation of the bone bases is a controversial subject in literature.
Most of the time, functional appliances are not recommended in vertical growth pattern
patients because these appliances can cause a subsequent clockwise mandibular rotation
and, consequently, may worsen the facial esthetics (18, 26).
Restriction of the maxilla, proclination of lower anteriors and being unsuitable in treatment
of vertical growers are the main disadvantages of traditional functional appliances. In order
to overcome these disadvantages and correct vertical growth pattern patients, R-Appliance
was designed.
Received: 20 August 2014
Accepted: 29 October 2014
* Corresponding author:
Associate Professor Abdolreza Jamilian,
DDS, PhD
Department of Orthodontics, Tehran Dental
Branch, Islamic Azad University
2713, Vali Asr St., Tehran 1966843133, Iran
Tel: 0098-21-22011892
Fax: 0098-21-22022215
e-mail: [email protected]
102
Methods and Materials:
Written consent was obtained from each patient or parent according to the ethical
principl