Airway in twin block /certified fixed orthodontic courses by Indian dental academy

ASSESSMENT OF ORO-PHARYNGEAL AIRWAY
DIMENSIONS IN SKELETAL CLASS II CASES
TREATED WITH TWIN BLOCK APPLIANCE

INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com


INTRODUCTION
 Mandibular deficiency may be a factor in reduced
oropharyngeal airway dimensions and related impaired
respiratory function.
 Functional appliance therapy has become an accepted
method for treatment of moderate and severe
discrepancies of sagittal jaw relation in growing
individuals.
 Functional appliances posture the mandible forward in a
permanent anterior position thereby altering the
neuromuscular environment of the dentition and bone.

AIMS & OBJECTIVES
 To

assess

the

changes

in

the

OAW

dimensions in Individuals with retrognathic
mandible treated with Twin Block functional
appliance to correct the skeletal class II
during the growth period.

REVIEW OF LITERATURE
 Murat Ozbek (1998) - OAW dimensions increased
significantly in treated patients, especially those with
sagittally
smaller
and
more
retrognathic
maxillomadibular complexes and smaller OAW
dimensions.
 Tourne (1991). A decreased patency of the OAW can
induce some postural adaptation which secure a
constant sagittal dimension at that level as in cases of
mandibular retrognathism.

 Lowe (1996) - Obstructive sleep apnea is caused by
repeated obstruction of the upper airway space during
sleep.
 Eung Kwon Pae (1997) - Hypothesized that respiratory
efficiency may be associated with anterior open bites.
Under this assumption that breathing efficiency of the
oropharynx

and

hypopharynx

may

pharyngeal airway length.

be

related

to

METHODOLOGY
 Study material was obtained from the Department
of Ortho, SDCH and comprised of lateral
Cephalograms, HWR, questionnaires and clinical
records. Sample included 10 individuals with
skeletal class II cases, of which 5 individuals
formed the control sample and 5 formed the
experimental sample who has been treated with
functional appliance.

SELECTION CRITERIA
(1) Patients of mixed dentition stage
(2) ANB > 3 degrees
(3) Skeletal class II case with mandibular retrognathism.
(4) No respiratory complaints
(5) Significant growth potential at the beginning of the
treatment period.
(6) Quality cephalogram at beginning and end of the
treatment period.
(7) Treatment by Twin Block Appliance.

CASE REPORTS

Figure 1 - Anatomic
landmarks used in the
study


Figure 3 - Oral airway (OAW) measurements of
the study: 1.Superior posterior airway space
(SPAS): Smallest distance between the
posterior border of the softpalate and the
posterior pharyngeal wall; 2.middle airway
space (MAS): Smallest distance between the
posterior border of the tongue and the
posterior pharyngeal wall, through the tip of
the soft palate (p); 3.Inferior airway space
(IAS): Smallest distance between the posterior
border of the tongue and the posterior
pharyngeal
wall;
Oropharyngeal
crosssectional area (ORO): The cross-sectional area
of the oropharynx between the ANS-PNS line
and a parallel line through epiglottis (shaded
area).


CASE 1
Master Navin
Pretreatment

SPAS - 9 mm
MAS - 11 mm
IAS - 9 mm
ORO - 1088.68mm2

Posttreatment

SPAS - 11 mm
MAS - 13 mm
IAS - 12 mm
ORO - 1319.16mm2

CASE2
Miss.Pheeba Mathew
Pretreatment

SPAS - 12 mm
MAS - 11 mm
IAS - 14 mm
ORO - 1672.57mm2

Posttreatment


SPAS - 14 mm
MAS - 13 mm
IAS - 16 mm
ORO - 1913.47mm2

Ashok Raja
Pretreatment

SPAS - 12 mm
MAS - 10 mm
IAS - 6 mm
ORO - 1069.83 mm2

CASE 3
Posttreatment


SPAS - 14 mm
MAS - 13 mm
IAS - 9 mm
ORO - 1303.03mm2

CASE 4
Thasreen
Pretreatment

Posttreatment

SPAS - 15 mm
MAS - 11 mm
IAS - 10 mm
ORO - 1282.29 MM2

SPAS - 18 mm
MAS - 13 mm
IAS - 12 mm
ORO - 1428.56 MM2


Prakash
Pretreatment

SPAS - 12 mm
MAS - 10 mm
IAS - 6 mm
ORO - 1069.83 mm2

CASE 5
Posttreatment


SPAS - 14 mm
MAS - 13 mm
IAS - 9 mm
ORO - 1303.03mm2

RESULTS
Control Group

Experimental Group

SPAS

12mm

13mm

10mm

12mm

MAS

11mm

11mm

11mm

13mm

IAS

14mm

13mm

9mm

12mm

1672mm2

1713,47mm2

1282.29mm2

1428.56mm2

ORO (Area)


DISCUSSION


Significant changes in the oropharyngeal airway dimension were
noted in our study, which revealed an increase in cross section
area by 202.25mm2 in OAW dimension compared to other study by
Ozbek at el. which revealed increase in Cross section area by
153.90mm2. The appliance used for correcting skeletal class II was
Clark's Twin Block appliance.



Ozbek stated that

functional orthopaedic treatment of growing

patients who have skeletal patterns with deficient mandible may
lead to increased OAW dimensions, thereby reducing the risk of
respiratory problems in the future.

CONCLUSION
 Our study revealed a significant increase in the OAW
dimensions in retrognathic mandible class II individuals
treated with Twin Block Appliance..
study

The cephalometric

using modified Pancherz's analysis revealed an

increase of 2-3mm in OAW dimensions among the
samples selected. Increase in OAW dimension may lead to
correction of problems such as snoring, upper airway
resistance syndrome and obstructive sleep apnea
syndrome

ACKNOWLEDGEMENT
My sincerest and heartful thanks to,
Prof. Dr. Rajagopal, MDS (Prof & HOD)
Prof. Dr. Venkatesan,
Prof. Dr. Shyamala Chandrasekar,
Prof. Dr. Umashankar,
Dr. Karthikeyan
And all my staffs and colleagues

Leader in continuing dental education


Airway in twin block /certified fixed orthodontic courses by Indian dental academy

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