Skeletal and Dental Changes from a Compliance-Based Orthotropic Treatment Approach with Exercises to Improve Orofacial Posture
Creators: Tavoossi, Faraz
Publisher: name: University of Alberta Library
Year: 2022

<p>Objective: To investigate the skeletal and dental changes that occur using a compliance-based orthotropic treatment approach with orofacial posture exercises aimed at controlling vertical facial skeletal growth in the mixed dentition. </p>

<p>Methods: 102 patients were consecutively treated under the same two-phased protocol by one clinician experienced in the technique. The first phase involved the use of upper and lower removable expansion appliances, supplemented by a series of daily compliance-based exercises designed to improve oral posture and strengthen orofacial musculature. The second phase consisted of the Mew Biobloc removable appliance designed to train for a closed mouth posture at rest. Lateral cephalometric radiographs were taken before treatment (T1) and at the completion of active treatment (T2). For the untreated control group, the AAOF Craniofacial Growth Legacy Collection database was thoroughly searched, and the lateral cephalometric radiographs of 75 patients closely matched for age, sex, and timeframe between T1 and T2 were selected. Using the Dolphin computer software, conventional skeletal and dental landmarks were digitally traced on all cephalograms. Changes in 13 skeletal and dental measurements were calculated and compared between the groups.</p>

<p>Results: Concerning sagittal skeletal measurements, the treatment group had a statistically significant 1.09° greater decrease in SNA and 1.47° greater decrease in ANB than the control (p &lt; .001). There was no difference in SNB and mandibular body length. Concerning vertical skeletal measurements, only the mean differences in gonial angle and lower facial height were statistically significantly different. Compared to the treatment group, the control group had a 1.23° greater decrease in gonial angle (p = .043) but a 1.62mm greater increase in lower facial height (p &lt; .001). There were statistically significant differences in all four dental measurements, most noticeably in incisor proclination. The treatment group experienced 8.49° greater proclination of maxillary incisors and 4.71° greater proclination of mandibular incisors, but 1.21mm and 1.17mm less overjet and overbite, respectively, compared to the control group (p &lt; .001). There was no statistically significant difference between males and females in the combined mean change in cephalometric measurements.</p>

<p>Conclusions: There is insufficient evidence to conclude that the treatment protocol has a meaningful effect on skeletal and dental changes. It is unlikely that the differences in the sagittal and vertical skeletal measurements were clinically significant after factoring in measurement errors, especially when considering the long treatment lengths. The treatment group did experience clinically significant incisor proclination. Sex also did not affect the magnitude of skeletal and dental changes over time, as males and females experienced the same growth changes regardless of whether they were in the treatment or control group.</p>