Original Research

Year : 2025 | Volume : 16 | Issue : 4 | Page : 77-90

A Comparison of Cervical Spine Postural Changes following Fixed and Removable Functional Appliance Therapy in Growing Class II Subjects

Bhargavi Ganesan1, Vignesh Kailasam2, Sridevi Padmanabhan3

1-Post Graduate Resident, 2-Professor, 3-Professor and Head,  Associate Dean Research, Department of Orthodontics and Dentofacial Orthopedics, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Chennai, 600116, India

Address for Correspondence:

Dr. Vignesh Kailasam

Professor and Head, Department of Orthodontics and Dentofacial Orthopaedics,

Sri Ramachandra Institute of Higher Education and Research (SRIHER)

Chennai, 600116, India

Email: vignesh.k@sriramachandra.edu.in

ABSTRACT     

Introduction: The objective was to compare the cervical spine postural changes after treatment with fixed and removable functional appliances.

Methods and Analysis: A retrospective study with pre and post lateral cephalograms of 60 patients was planned. They were divided into three groups- fixed functional appliance, removable functional appliance and a control group which involved camouflage mechanics. Cervical spine posture and airway were assessed. The craniocervical angulation changes were correlated to changes in ANB, mandibular parameters and airway.

Results: Amongst the cervical spine postural variables, only the sella-nasion to odontoid process tangent (SN-OPT) showed significant changes (Twin block/control, p=0.041). Removable and fixed functional appliances brought about a reduction in the SN-OPT. However, this was not statistically significant (Herbst/control=0.184; Herbst/Twin block, p=0.761). Control group revealed an increase in the SN-OPT and this difference was significant between Twin block and control group (p=0.041). There were significant variations in the SNB (p=0.000) and ANB (Herbst/control, p=0.003; Twin block/control, p=0.001) between both Herbst and Twin block groups when compared with control group. However, there were no significant differences between the Herbst and Twin block groups (SNB, p=0.333;ANB,p=0.974). There were no significant differences in the mandibular length and the mandibular plane angle between the three groups (mandibular length, p=0.206; mandibular plane angle, p=0.788). Changes in superior, middle and inferior pharyngeal airway were not significantly different between the three groups (p=.537; p=.354; p=.110 respectively).

Conclusion: The functional appliances did not affect significant changes in the cervical spine posture. There were no significant differences between fixed and removable functional appliances.
Keywords: Cervical spine posture; Orthodontic appliances; Fixed functional appliances; Removable functional appliances.

FUNDING STATEMENT

This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

COMPETING INTERESTS

No competing interests

RESEARCH ETHICAL APPROVAL

Ethical approval from the Institutional Ethics Committee was obtained. CSP/20/OCT/86/172

How to cite this article: Bhargavi Ganesan, Vignesh Kailasam, Sridevi Padmanabhan. A Comparison of Cervical Spine Postural Changes following Fixed and Removable Functional Appliance Therapy in Growing Class II Subjects. Int J Orthod Rehabil 2025; 16 (4): 77-90.

Review Article

Year : 2025 | Volume : 16 | Issue : 1 | Page : 24-37

Prognostic Factors for Successful Functional Appliance Therapy in Skeletal Class II Malocclusion- A Systematic Review

Rajkumaran Rajamanickam1, Bhadrinath Srinivasan2, Keerthi Venkatesan3 , Vignesh Kailasam4

1-Post Graduate Resident, 2-Associate Professor, 3-Senior Lecturer, 4-Professor and Head, Department of Orthodontics and Dentofacial Orthopedics, Sri Ramachandra Dental College & Hospital, Porur, Chennai-600116, India.

Address for Correspondence:

Dr Bhadrinath Srinivasan

Associate professor,

Department of Orthodontics and Dentofacial Orthopedics,

Sri Ramachandra Dental College & Hospital, Porur, Chennai-600116.

E-mail – bhadrinath.s@sriramachandra.edu.in

Phone - +91 9841879224

ABSTRACT

AIM: To investigate clinical or cephalometric parameters that contribute to favourable outcomes with functional appliance therapy in skeletal class II malocclusion.

MATERIALS AND METHODS: Six electronic databases were searched PubMed, Ovid, Lilacs, Cochrane, Scopus, and Web of Science up to 25thFebruary 2025. All study designs which evaluated factors associated with favourable and unfavourable outcome with functional appliance therapy for the treatment of skeletal class II malocclusion were included. The electronic search, initial screening, data extraction, risk of bias assessment was independently performed by the two reviewers. The collected data were analysed from the finally selected articles based on type of study, sample size, type of functional appliance used, and patient characteristics or factors studied which could be considered as positive predictive factors for functional appliance.

RESULTS: Seven retrospective studies and one prospective study were included. Prognostic factors like  the Co-Go-Me angle, chin position, growth pattern and other occlusal factors such as overbite, overjet were evaluated in the selected studies. Four studies were rated very good with 9 points and four other studies were rated as satisfactory with 7 points using the Newcastle Ottawa Scale. Due to heterogeneity of the factors studied, a meta–analysis could not be conducted in this systematic review.

CONCLUSION: Two included studies reported Co- Go-Me angle as the single most important predictive factor for successful outcome. Cephalometric factors pointing to horizontal growth pattern or hypo divergence, chin position and occlusal variables like increased overbite and overjet were identified as positive predictive factors. However future studies with definitive comparison groups can strengthen the current evidence.

REGISTRATION: PROSPERO(CRD42022312039).

CONFLICT OF INTEREST DISCLOSURE

All the authors disclose they do not have any financial or non-financial interests that are directly or indirectly related to the work submitted for publication.

 All the authors declare that the manuscript has been read and approved by all  of them , that the requirements for authorship as stated earlier in this document have been met, and that each author believes that the manuscript represents honest work.

All the authors declare that they do not have any competing interests

FUNDING

There was no external funding.

How to cite this article: Rajkumaran Rajamanickam, Bhadrinath Srinivasan, Keerthi Venkatesan , Vignesh Kailasam. Prognostic Factors for Successful Functional Appliance Therapy in Skeletal Class II Malocclusion- A Systematic Review. Int J Orthod Rehabil 2025; 16 (1) 24-37.