## 4 Discussion
[PERSON] reported that the increase in sagittal condylar growth was the highest during and just before the pubertal growth spurt [43]. Thus, to maximize treatment effects, we included individuals with a growth stage just before the pubertal growth spurt CS2 and at the peak of the pubertal growth spurt CS3. Sex is a factor that affects growth, and males and females may respond differently to functional therapy. [PERSON] et al. compared the effects of Herbst and TB appliances in individuals with Class II division 1 malocclusions and found that girls responded better to therapy than boys [13]. Hence, this study tried to ensure an equal distribution of boys and girls between the groups (\(p\) = 0.837). Of all tooth-borne functional appliances, the TB is the most commonly used [14]. The major reason why the TB is preferred over other appliances in the clinic can be attributed to the high level of patient acceptance [44]. There is no objective evidence regarding patient adherence, but reports have suggested that patients prefer wearing a TB appliance over other appliances as it is smaller in size and therefore, more aesthetic, and it permits more normal speech patterns [44; 45]. In addition to these advantages for the patient, the TB can produce greater skeletal modification than fixed functional appliances [44]. Furthermore, the TB can be used in patients with both short and long lower face heights [45], and it allows the addition of an expansion screw when needed. For these reasons, the TB appliance was used in the present study. Regarding the activation protocol during functional therapy, some researchers observed no difference between single-step and stepwise activation of the mandible sagittally [46; 47], whereas others have noted that, with stepwise activation, each step provides a new stimulus for condylar growth [48]. In this study, we used single-step activation. If needed, further activation was achieved in the patients after this study's completion. Achieving a change in the bony structure of the condyle requires 6 months [49]. However, given that no studies have experimented with KT on the face for as long as 6 months, after seeking expert opinion, we conducted our study for 3 months. Moreover, the thickening and proliferation of the condylar cartilage induced by functional stimuli occur in as little as 2 weeks and then disappear [50]. KT produces most of its effects in the early phases of therapy and has no significant effect after a few weeks [37]. Two-dimensional radiographs are widely used for imaging the TM] for various reasons, including ease of access, practicality, and lower cost [51]. However, these images are adversely affected by various factors, including anatomical superposition, beam projection angle, and patient position, as well as variations in condylar shape and dimensions, which cast doubt on the validity of these modalities [52]. In contrast, three-dimensional modalities provide more accurate measurements in the assessment of the TMJ [53]. In the imaging of joints, CT performs well in revealing bony alterations, whereas magnetic resonance imaging (MRI) is effective at identifying the soft tissues of the disk and internal irregularities [54]. Several studies investigating the morphology of the condyles found CT to be superior to MRI in the assessment of bony changes in the TMJ [55]. Compared with CT, cone-beam computed tomography (CBCT) uses less radiation to acquire images [56]. Based on the ALARA (as low as reasonably achievable) principle, the anatomical structures that constitute the TMJ area yield very good images at exposure levels well below those that achieve the highest image quality [57]. In this study, acquisition parameters were modified based on the ALARA principle, and scans were limited to the clinically examined area to use a radiation dose comparable to that used in CBCT. Studies showed that CT is highly accurate in volumetric measurements [58].