Home | About Us | Editorial Board | Current Issue | Archives | Search | Instructions | Subscription | Feedback | e-Alerts | Login 
Journal of Indian Society of Pedodontics and Preventive Dentistry Official publication of Indian Society of Pedodontics and Preventive Dentistry
 Users Online: 1302  
 
  Print this page Email this page   Small font sizeDefault font sizeIncrease font size


 
  Table of Contents    
CASE REPORT
Year : 2010  |  Volume : 28  |  Issue : 3  |  Page : 237-240
 

Use of a modified anterior inclined plane in the treatment on the dentoskeletal Class II division 2 patient


1 PG Resident, Department of Pediatric Dentistry, Christian Dental College, Brown Road, Ludhiana, Punjab, India
2 Principal, Department of Pediatric Dentistry, Christian Dental College, Brown Road, Ludhiana, Punjab, India
3 Principal and Professor, Department of Pediatric Dentistry, Christian Dental College, Brown Road, Ludhiana, Punjab, India

Date of Web Publication11-Dec-2010

Correspondence Address:
S A Rao
Department of Pediatric Dentistry, Christian Dental College, Brown Road, Ludhiana - 141 008, Punjab
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-4388.73782

Rights and Permissions

 

   Abstract 

Class II malocclusions are seen due to the underdevelopment of the mandible in most of the cases. To compensate for the mandible retrusive position, there is flaring of the lower anterior teeth or retroclination of the central incisors as a compensatory mechanism seen in Class II division 2 type of malocclusion. This case report evaluates the skeletal and dental changes when a 12-year-old female patient with Class II div 2 malocclusion was treated with a modified anterior inclined plane. The postreatment data suggested that there were no significant changes in the vertical skeletal parameters. The upper central incisors were significantly realigned by proclination along with retroclination of the lateral incisors. There was significant increase in the mandibular length. The results revealed that the modified anterior inclined plane showed good results in the treatment of a case of Class II div 2 malocclusion.


Keywords: Functional therapy, inclined plane, skeletal Class II div 2 malocclusion


How to cite this article:
Rao S A, Thomas A M, Chopra S. Use of a modified anterior inclined plane in the treatment on the dentoskeletal Class II division 2 patient. J Indian Soc Pedod Prev Dent 2010;28:237-40

How to cite this URL:
Rao S A, Thomas A M, Chopra S. Use of a modified anterior inclined plane in the treatment on the dentoskeletal Class II division 2 patient. J Indian Soc Pedod Prev Dent [serial online] 2010 [cited 2019 Nov 15];28:237-40. Available from: http://www.jisppd.com/text.asp?2010/28/3/237/73782



   Introduction Top


Functional appliances are powerful appliances capable of impressive changes in the position of the teeth. These appliances direct the pattern and direction of growth of the jaws by alteration of the forces produced by the whole neuromuscular component. [1],[2],[3]

They are generally used for Class II div 1 malocclusions, although they can be used for the correction of Class II div 2 and Class III malocclusions on occasion. They are either removable from the mouth or fixed to the teeth, and work by stimulating the muscles of mastication and soft tissues of the face. Majority of the appliances are used in the correction of Class II malocclusions by stimulating the growth of the mandible. Changes are induced by holding the mandible forward and the ensuing reaction of the stretched muscles and soft tissues, transmitted to the periosteum, bones and the teeth. [4] A restraining effect on the growth of the maxilla and the maxillary dentoalveolar complex is also seen along with the stimulation of mandibular growth and mandibular alveolar adaptation. Favorable changes in temporomandibular joint also occur. [5],[6],[7]

The most common appliance used is the twin block appliance, which eliminates the major disadvantage of other functional appliances, such as activator, bionator, and Frankel's vestibular appliances, which are fabricated in one piece to fit the teeth in both the jaws due to which the patient cannot eat or speak and hence finds it uncomfortable for full-time wear.

The twin block though the most preferred and used appliance still has its own disadvantages, in that it still is somewhat bulky, and some amount of discomfort exists with speech and mastication. The other problem is that it has a long treatment time with the appliance being changed and altered in the supportive and retentive phase. [8],[9],[10]

To do away with disadvantages of the twin block and other functional appliances, the anterior inclined plane was developed. [11] The inclined plane is a removable intermaxillary appliance that forces the mandible to move in a forward position during the mandibular functional activity, particularly during the swallowing period. Protractor muscle involvement results in the intermittent activation of the retractor muscles that leads to favorable bone remodeling.

In comparison with the traditional functional appliances, this appliance does not restrict the three-dimensional mandibular movement nor does it interfere with the regular physiologic activity of the oral cavity, which has a great impact on the patient cooperation, and it requires less effort by the patient to follow oral hygiene instructions. The anterior inclined appliance has shown good results in the treatment of Class II div 1 patients.

There still exists a concern in the treatment of Class II div 2 malocclusion cases. The twin block has a modification for the same but the appliance still has the same disadvantages of the regular twin block. The other option includes converting the Class II div 2 to a Class II div 1 case and to continue the treatment. This whole procedure becomes time-consuming and cumbersome.

In this study, we used an anterior inclined plane within which was incorporated a double cantilever spring to treat a case of Class II div 2 malocclusion.


   Case Report Top


A 12-year-old female presented with retroclined maxillary central incisors and proclined maxillary lateral in the Department of Pediatric and Preventive Dentistry. The patient was in the mixed dentition stage with a skeletal Class II-jaw base relationship. She had bilaterally retained upper and lower first and second deciduous molars. The patient also had with anterior deep bite, which is a typical presentation of a Class II div 2 malocclusion [Figure 1]. Radiographs revealed the presence of all permanent teeth except upper right second premolar, which was congenitally absent.
Figure 1: Pretreatment frontal view

Click here to view


An anterior inclined plane was incorporated in the upper arch with a double cantilever spring to procline the central incisors [Figure 2] and [Figure 3]. The inclined plane is a removable appliance wherein during mouth closure; the mandible moves in the forward position. The appliance was constructed in such a manner that as the central incisors proclined, the mandible glided forward utilizing the incline created palatal to the lateral incisors. So the appliance did not need to be modified with the proclination of the central incisors. Once the central incisors had sufficiently proclined, the labial bow was also activated to retrocline the lateral incisors with adequate clearance of acrylic on the palatal side of these teeth.
Figure 2: Appliance in the mouth

Click here to view
Figure 3: Frontal view of appliance in mouth

Click here to view


The patient visited once every week for the cantilever spring and the labial bow activation thereafter.


   Results Top


Comparisons of the pretreatment and posttreatment data of the pretreatment and posttreatment are shown in [Table 1]. The comparison of the cephalometric measurements revealed that the appliance had not much skeletal effect on the maxilla. There was no change in the sella-nasion-pt A (SNA) angle. The skeletal vertical parameters were evaluated and no significant change was found in sella-nasion-mandibular plane (SN-MP) and Y axis. When the measurements of the mandible were evaluated, significant changes were found. The Pt A-nasion-Pt B (ANB) angle demonstrated a decrease of 1° when the 2 cephalograms were compared. Changes in Articulare-pt B (Ar-B), articulare-pogonion (Ar-Pog), and sella-nasion-pt B (SNB) were significant. The dental changes caused by the inclined plane were obvious. The upper central incisors were significantly realigned by proclination along with retroclination of the lateral incisors [Figure 4],[Figure 5] and [Figure 6].
Figure 4: Posttreatment frontal view

Click here to view
Figure 5: Occlusion right side-posttreatment

Click here to view
Figure 6: Occlusion left side-posttreatment

Click here to view
Table 1: Comparison of pre treatment and post treatment dentoskeletal changes with inclined plane treatment

Click here to view



   Discussion Top


A review of the literature shows that there have been no studies done so far in the use of the reverse inclined plane in the treatment of Class II div 2 malocclusion. There is only one study where the reverse inclined plane has been used in the treatment of 25 cases of Class II div 1 cases with promising results. Anterior inclined plane application in a previous study and in our case overcame many disadvantages of the conventional functional appliances. In this study, the results of treatment in Class II div 2 with this type of appliance are evaluated. The inclined plane is a removable intramaxillary appliance that forces the mandible to move in a forward position during the mandibular functional activity, particularly during the swallowing period. [11] In this appliance, we also incorporated a double cantilever spring for proclination of the central incisors and also a labial bow was incorporated to retrocline the lateral incisors into the arch.

In comparison with the traditional functional appliances, this appliance does not restrict the three-dimensional mandibular movement nor it interferes with the regular physiologic activity of the oral cavity, which has a great impact on the patient cooperation, and it requires less effort by the patient to follow oral hygiene instructions.

This method is more effective in early stages of Class II deep bite malocclusion treatment, particularly to redirect the mandibular growth anteriorly and vertically by eliminating the lack of occlusion that acts as a physical barrier against the normal growth of the mandible. [1],[12] This appliance prevents the further extrusion of the upper and lower anterior teeth because of the loss of anterior incisal contact. It provides a greater extrusion of the lower posterior teeth and this helps to correct the Class II relationship and opens the bite simultaneously in the early mixed dentition period.

The results showed that Class II correction was achieved mostly through dentoalveolar and skeletal changes of the mandible and revealed that the appliance had no effect on the nasomaxillary growth component. Inclined plane favorably improved the profile and the double cantilever spring proclined the upper central incisors. As the position of the incisors improved so did the contour of the upper lip resulting in better esthetics and improved profile.

 
   References Top

1.Mills JR. The effect of functional appliances on the skeletal pattern. Br J Orthod 1991;18:267-75.  Back to cited text no. 1
[PUBMED]    
2.McNamara JA, Howe RP, Dischinger TG. A comparison of the Herbst and Frankel appliances in the treatment of Class II malocclusion. Am J Orthod Dentofacial Orthop 1990;98:134-44.  Back to cited text no. 2
    
3.Chen JY, Will LA, Niederman R. Analysis of efficacy of functional appliances on mandibular growth. Am J Orthod Dentofacial Orthop 2002;122:470-6.  Back to cited text no. 3
[PUBMED]  [FULLTEXT]  
4.Pangrazio-Kulbersh V, Berger JL, Chermak DS, Kaczynski R, Simon ES, Haerian A. Treatment effects of the mandibular anterior repositioning appliance on patients with Class II malocclusion. Am J Orthod Dentofacial Orthop 2003;123:286-95.  Back to cited text no. 4
[PUBMED]  [FULLTEXT]  
5.Valant JR, Sinclair PM. Treatment effects of the Herbst appliance. Am J Orthod Dentofacial Orthop 1989;95:138-47.  Back to cited text no. 5
[PUBMED]  [FULLTEXT]  
6.Blackwood HO. Clinical management of the Jasper Jumper. J Clin Orthod 1991;25:755-60.  Back to cited text no. 6
    
7.Mills CM, McCulloch KJ. Case report: Modified use of the Jasper Jumper appliance in a skeletal Class II mixed dentition case requiring palatal expansion. Angle Orthod 1997;67:277-82.  Back to cited text no. 7
[PUBMED]    
8.Weiland FJ, Bantleon HP. Treatment of Class II malocclusions with the Jasper Jumper appliance. A preliminary report. Am J Orthod Dentofacial Orthop 1995;108:341-50.  Back to cited text no. 8
[PUBMED]  [FULLTEXT]  
9.Kucukkeles N, Orgun A. Correction of Class II malocclusions with a Jasper Jumper in growing patients. Eur J Orthod 1995;17:445.  Back to cited text no. 9
    
10.Sari Z, Goyence Y, Doruk C, Usumes S. Comparative evaluation of a new removable jasper jumper functional appliance vs an activator-headgear combination. Angle Orthod 2002;73:286-93.  Back to cited text no. 10
    
11.Emami MS, Jamilian A, Showkatbakhsh A. The effect of anterior inclined plane treatment on the dentoskeletal of Class II division 1 patients. J Indian Soc Pedod Prev Dent 2007;25:130-2.  Back to cited text no. 11
[PUBMED]  Medknow Journal  
12.Wieslander L, Lagerstrφm L. The effect of activator treatment on class II malocclusions. Am J Orthod 1979;75:20-6.  Back to cited text no. 12
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]
 
 
    Tables

  [Table 1]


This article has been cited by
1 Effect of seasonal variation on the composition and properties of raw milk destined for processing in the UK
Biye Chen,Michael J. Lewis,Alistair S. Grandison
Food Chemistry. 2014; 158: 216
[Pubmed] | [DOI]



 

Top
Print this article  Email this article
 

    

 
  Search
 
  
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Article in PDF (1,685 KB)
    Citation Manager
    Access Statistics
    Reader Comments
    Email Alert *
    Add to My List *
* Registration required (free)  


    Abstract
    Introduction
    Case Report
    Results
    Discussion
    References
    Article Figures
    Article Tables

 Article Access Statistics
    Viewed11949    
    Printed170    
    Emailed4    
    PDF Downloaded670    
    Comments [Add]    
    Cited by others 1    

Recommend this journal


Contact us | Sitemap | Advertise | What's New | Copyright and Disclaimer 
  2005 - Journal of Indian Society of Pedodontics and Preventive Dentistry | Published by Wolters Kluwer - Medknow 
Online since 1st May '05