CODS - Journal of Dentistry

Register      Login

VOLUME 12 , ISSUE 1 ( January-June, 2020 ) > List of Articles


Cephalometric Evaluation of Stability of Airway Changes Obtained with Twin-block Therapy

Garima Gupta, Mala R Manohar

Citation Information : Gupta G, Manohar MR. Cephalometric Evaluation of Stability of Airway Changes Obtained with Twin-block Therapy. CODS J Dent 2020; 12 (1):2-6.

DOI: 10.5005/jp-journals-10063-0063

License: CC BY-NC 4.0

Published Online: 05-04-2021

Copyright Statement:  Copyright © 2020; The Author(s).


Background: Mandibular retrognathism or functional mandibular retrusion is commonly associated with the reduced pharyngeal airway. Functional appliances that are used to treat mandibular retrusion have been found to improve airway dimensions. However, this improvement in the airway has never been assessed in the long-term. Therefore, the purpose of this study was to assess the effects of standard twin-block appliance on pharyngeal airway space in subjects with skeletal class-II pattern and the maintenance of changes achieved after debonding. Materials and methods: Twenty-five subjects (14 females and 11 males) in the age-group of 10–14 (mean 12.08 ± 0.91) underwent treatment of a class II division 1 malocclusion via standard twin-block appliance followed by fixed orthodontic therapy. Pre-treatment (T1), post-twin block (T2), and post-fixed appliance (T3) lateral cephalograms were taken and skeletal and soft tissue landmarks were hand-traced. A pairwise comparison was used to assess whether there were any significant differences in the cephalometric variables of the upper and lower pharyngeal airway between each phase of treatment (T1, T2, T3). Results: There was a significant increase in sagittal dimensions of upper and lower pharyngeal space with a mean increase of 1.34 and 1.26 mm, respectively, following twin-block therapy. There was a significant increase in upper pharyngeal space from pre-treatment till the end of the fixed appliance phase (p < 0.003) and the change in lower pharyngeal space from pre-treatment till the end of the fixed appliance phase was non-significant (p = 0.13). Conclusion: Correction of mandibular retrusion in class II malocclusion subjects by twin-block therapy increased the sagittal dimension of the upper and lower pharyngeal space. This significant improvement in the upper pharyngeal space was maintained till the end of fixed orthodontic treatment. However, the improvement in the lower pharyngeal space was found to be unstable post-debonding.

  1. Linder-Aronson S, Henrikson CO. Radiocephalometric analysis of anteroposterior nasopharyngeal dimensions in 6- to 12-year-old mouth breathers compared with nose breathers. ORL 1973;35(1):19–29. DOI: 10.1159/000275083.
  2. Robin P. Glossoptosis due to atresia and hypotrophy of the mandible. Am J Dis Child 1934;48(3):541–547. DOI: 10.1001/archpedi.1934.01960160063005.
  3. Ozbek MM, Memikoglu TUT, Gogen H, et al. Oropharyngeal airway dimensions and functional orthopaedic treatment in skeletal class 2 cases. Angle Orthod 1998;68:327–336.
  4. Jena AK, Singh SP, Utreja AK. Sagittal mandibular development effects on the dimensions of the awake pharyngeal airway passage. Angle Orthod 2010;80(6):1061–1067. DOI: 10.2319/030210-125.1.
  5. McNamara JA. A method of cephalometric evaluation. Am J Orthod 1984;86(6):449–469. DOI: 10.1016/S0002-9416(84)90352-X.
  6. Martin SE, Mathur R, Marshall I, et al. The effect of age, sex, obesity and posture on upper airway size. Eur Resp J 1997;10(9):2087–2090. DOI: 10.1183/09031936.97.10092087.
  7. Battagel JM, Johal A, Kotecha B. A cephalometric comparison of subjects with snoring and obstructive sleep apnea. Eur J Orthod 2000;22(4):353–365. DOI: 10.1093/ejo/22.4.353.
  8. Malkoc S, Usumez S, Nur M, et al. Reproducibility of airway dimensions and tongue and hyoid positions on lateral cephalograms. Am J Orthod Dentofacial Orthop 2005;128(4):513–516. DOI: 10.1016/j.ajodo.2005.05.001.
  9. Yassaei S, Tabatabaei Z, Ghafurifard R. Stability of pharyngeal airway dimensions: tongue and hyoid changes after treatment with a functional appliance. Int J Orthod Milwaukee 2012;23:9–15.
  10. Hänggi MP, Teuscher UM, Roos M, et al. Long-term changes in pharyngeal airway dimensions following activator-headgear and fixed appliance treatment. Eur J Orthod 2008;30(6):598–605. DOI: 10.1093/ejo/cjn055.
  11. Kinzinger G, Czapka K, Ludwig B, et al. Effects of fixed appliances in correcting angle class II on the depth of the posterior airway space. J Orofacial Orthop 2011;72(4):301–320. DOI: 10.1007/s00056-011-0035-2.
  12. Schutz TCB, Dominguez GC, Hallinan MP, et al. Class II correction improves nocturnal breathing in adolescents. Angle Orthod 2011;81(2):222–228. DOI: 10.2319/052710-233.1.
  13. Yen-Chun Lin YC, Hsiang-Chien Lin HC, Tsai HH. Changes in the pharyngeal airway and position of the hyoid bone after treatment with a modified bionator in growing patients with retrognathia. J Exp Clin Med 2011;3(2):93–98. DOI: 10.1016/j.jecm.2011.02.005.
  14. Han S, Choi YJ, Chung CJ, et al. Long-term pharyngeal airway changes after bionator treatment in adolescents with skeletal class II malocclusions. Korean J Orthod 2014;44(1):13–19. DOI: 10.4041/kjod.2014.44.1.13.
  15. Ghodke S, Utreja AK, Singh SP, et al. Effects of twin-block appliance on the anatomy of pharyngeal airway passage (PAP) in class II malocclusion subjects. Prog Orthod 2014;15(1):68. DOI: 10.1186/s40510-014-0068-3.
  16. Jena AK, Singh SP, Utreja AK. Effectiveness of twin-block and mandibular protraction appliance-IV in the improvement of pharyngeal airway passage dimensions in class II malocclusion subjects with a retrognathic mandible. Angle Orthod 2013;83(4):728–734. DOI: 10.2319/083112-702.1.
  17. Kannan A, Sathyanarayana HP, Padmanabhan S. Effect of functional appliances on the airway dimensions in patients with skeletal class II malocclusion: a systematic review. J Orthodont Sci 2017;6(2):54–64. DOI: 10.4103/jos.JOS_154_16.
  18. Almeida FR, Lowe AA, Sung JO, et al. Long-term sequellae of oral appliance therapy in obstructive sleep apnea patients: Part 1. Cephalometric analysis. Am J Orthod Dentofacial Orthop 2006;129(2):195–204. DOI: 10.1016/j.ajodo.2005.10.001.
  19. Battagel JM, Johal A, L'Estrange PR, et al. Changes in airway and hyoid position in response to mandibular protrusion in subjects with obstructive sleep apnoea (OSA). Eur J Orthod 1999;21(4):363–376. DOI: 10.1093/ejo/21.4.363.
  20. Kollias I, Krogstad O. Adult craniocervical and pharyngeal changes--a longitudinal cephalometric study between 22 and 42 years of age. Eur J Orthod 1999;21(4):345–355. DOI: 10.1093/ejo/21.4.345.
  21. Cohen AM, Vig PA. A serial growth study of the tongue and intermaxillary space. Angle Orthod 1976;46:332–337.
  22. Poon KH, Chay SH, Choing KFW. Airway and craniofacial changes with mandibular Advancment device in chinese with obstructive sleep apnoea. Ann Acad Med Singapore 2008;37(8):637–644.
  23. Liu Y, Zeng X, Fu M, et al. Effects of a mandibular repositioner on obstructive sleep apnea. Am J Orthod Dentofacial Orthop 2000;118(3):248–256. DOI: 10.1067/mod.2000.104831.
  24. Doff MH, Hoekema A, Pruim GJ, et al. Effects of a mandibular advancement device on the upper airway morphology: a cephalometric analysis. J Oral Rehabil 2009;36(5):330–337. DOI: 10.1111/j.1365-2842.2009.01946.x.
  25. Verma G, Tandon P, Nagar A, et al. Cephalometric evaluation of hyoid bone position and pharyngeal spaces following treatment with twin block appliance. J Orthod Sci 2012;1(3):77–82. DOI: 10.4103/2278-0203.103863.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.