Cervical Extraoral Traction Therapy in Early Treatment of Class II Malocclusion. A systematic review

Eliana Yepes, Zulma Vanessa Rueda, Paola Botero-Mariaca

Resumen


Introduction and objective: Cervical headgear has been used for decades as a treatment of class II malocclusion. Although the effects have been reported previously they are somewhat contradictory. The objective was to determine the available scientific evidence that supports the parameters of clinical use for therapy with cervical extraoral traction in early treatment for class II malocclusion. Materials and methods: A systematic search was conducted using Medline, Google Scholar, Cochrane, and Lilacs databases. The search involved articles in English, Spanish, Portuguese, and German using previously selected MeSH terms and free-text terms. The search included articles dealing with cervical extraoral traction treatment, systematic reviews, meta-analysis, clinical trials, and cohort, case-control, and cross-sectional studies. Methodological quality was evaluated using various scales according to the type of study. Results: The search generated 334 articles, 259 were eliminated because they were duplicates, and 34 were eliminated because they did not meet the inclusion criteria. 41 articles were evaluated in full text, 21 were excluded because they did not meet the inclusion criteria, leaving a total of 20 articles. Conclusions: The articles offered varied, yet clear, recommendations. According to the literature and clinical judgment, treatment timing is recommended during the pubertal growth spurt. The most efficient force is 450 to 500g per side for 12 to 14 hours per day. A long outer bow bent 15o degrees upward should be used in patients with normal and hypodivergent patterns. Maxillary growth control depends on age, force, treatment duration, etc. Changes in overjet can be expected due to changes in dental inclination, growth, or the use of additional appliances; an average molar distalization of 1 mm to 2 mm can be achieved.

 

Terapia de tracción extraoral cervical en el tratamiento temprano de la maloclusión de clase II. Una revisión sistemática

Introducción y objetivo: La Tracción cervical se ha utilizado durante décadas como tratamiento para la maloclusión de clase II. Aunque los efectos se han informado previamente, son algo contradictorios. El objetivo fué determinar la evidencia científica disponible que respalde los parámetros de uso clínico para la terapia con tracción extraoral cervical en el tratamiento temprano de la maloclusión de clase II. Materialesy métodos: Se realizó una búsqueda sistemática utilizando las bases de datos Medline, Google Scholar, Cochrane y Lilacs. La búsqueda incluyó artículos en inglés, español, portugués y alemán utilizando términos MeSH previamente seleccionados y términos de texto libre. La búsqueda incluyó artículos relacionados con el tratamiento de tracción extraoral cervical, revisiones sistemáticas, metanálisis, ensayos clínicos y estudios de cohortes, casos y controles y estudios transversales. La calidad metodológica se evaluó utilizando varias escalas según el tipo de estudio. Resultados: La búsqueda generó 334 artículos, 259 fueron eliminados porque eran duplicados y 34 fueron eliminados porque no cumplían con los criterios de inclusión. Se evaluaron 41 artículos en texto completo, se excluyeron 21 porque no cumplían con los criterios de inclusión, dejando un total de 20 artículos. Conclusiones: Los artículos ofrecieron recomendaciones variadas, pero claras. De acuerdo con la literatura y el juicio clínico, se recomienda el momento del tratamiento durante el período de crecimiento puberal. La fuerza más eficiente es de 450 a 500 g por lado durante 12 a 14 horas por día. Se debe usar un arco externo largo doblado 15 grados hacia arriba en pacientes con patrones normales e hipodivergentes. El control del crecimiento maxilar depende de la edad, la fuerza, la duración del tratamiento, etc. Se pueden esperar cambios en la sobrecarga debido a cambios en la inclinación dental, el crecimiento o el uso de aparatos adicionales. Se puede lograr una distalización molar promedio de 1 mm a 2 mm.

Palabras clave: tracción extraoral cervical, maloclusión clase II, tratamiento temprano.

 

Terapia de Tração Extraoral Cervical no Tratamento Precoce da Maloclusão Classe II. Uma revisão sistemática

Introdução e objetivo: A tração cervical tem sido utilizada como tratamento da má oclusão de classe II. Embora os efeitos tenham sido relatados anteriormente, eles são contraditórios. O objetivo foi determinar as evidências científicas disponíveis que suportam os parâmetros de uso clínico para terapia com tração extraoral cervical no tratamento precoce da má oclusão de classe II. Materiais e métodos: Uma pesquisa sistemática foi realizada usando Medline, Google Scholar, Cochrane e Lilacs. Foram incluidos artigos em inglês, espanhol, português e alemão, usando termos MeSH selecionados anteriormente e termos de texto livre. A pesquisa incluiu artigos que tratavam do tratamento da tração extraoral cervical, revisões sistemáticas, meta-análise, ensaios clínicos e estudos
de coorte, caso-controle e transversais. A qualidade metodológica foi avaliada usando várias escalas de acordo com o tipo de estudo. Resultados: a busca gerou 334 artigos, 259 foram eliminados por serem duplicados e 34 foram eliminados por não atenderem aos critérios de inclusão. 41 artigos foram avaliados em texto completo, 21 foram excluídos por não atenderem aos critérios de inclusão, totalizando 20 artigos. Conclusões: Os artigos oferecidos apresentaram recomendações variadas, porém claras. De acordo com a literatura e o julgamento clínico, o momento do tratamento é recomendado durante o surto de crescimento puberal. A força mais eficiente é de 450 a 500g por lado, durante 12 a 14 horas por dia. Um arco externo longo e dobrado de 15 graus deve ser usado em pacientes com padrões normais e hipodivergentes. O controle do crescimento maxilar depende da idade, força, duração do tratamento, etc. Alterações no overjet podem ser esperadas devido a alterações na inclinação dentária, crescimento ou uso de aparelhos adicionais; uma distalização molar média de 1 mm a 2 mm pode ser alcançada.

Palavras-chave: tração extraoral cervical, má oclusão classe II, tratamento precoce.


Palabras clave


cervical extraoral traction, class II malocclusion, early treatment.

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Referencias


Melsen B, Enemark H. Effect of cervical anchorage studied by the implant method.

Rep Congr Eur Orthod Soc. 1969;435–447.

Wieslander L. The effect of force on craniofacial development. Am J Orthod. 1974

May;65(5):531–538.

Baumrind S, Molthen R, West EE, Miller DM. Mandibular plane changes during

maxillary retraction. Am J Orthod. 1978;74(1):32–40.

Melsen B. Effects of cervical anchorage during and after treatment: an implant

study. Am J Orthod. 197873(5):526–540.

Tulloch JF, Proffit WR, Phillips C. Influences on the outcome of early treatment for

Class II malocclusion. Am J Orthod Dentofac Orthop Off Publ Am Assoc Orthod Its

Const Soc Am Board Orthod. 1997111(5):533–542.

Tulloch JF, Phillips C, Proffit WR. Benefit of early Class II treatment: progress

report of a two-phase randomized clinical trial. Am J Orthod Dentofac Orthop Off

Publ Am Assoc Orthod Its Const Soc Am Board Orthod. 1998;113(1):62–72, quiz

–74.

Kirjavainen M, Kirjavainen T, Hurmerinta K, Haavikko K. Orthopedic cervical

headgear with an expanded inner bow in class II correction. Angle Orthod.

;70(4):317–325.

Henriques FP, Janson G, Henriques JFC, Pupulim DC. Effects of cervical headgear

appliance: a systematic review. Dent Press J Orthod. 2015;20(4):76–81.

Pirttiniemi P, Kantomaa T, Mäntysaari R, Pykäläinen A, Krusinskiene V, Laitala T, et

al. The effects of early headgear treatment on dental arches and craniofacial morphology:

an 8 year report of a randomized study. Eur J Orthod. 2005;27(5):429–436.

Papageorgiou SN, Kutschera E, Memmert S, Gölz L, Jäger A, Bourauel C, et al.

Effectiveness of early orthopaedic treatment with headgear: a systematic review

and meta-analysis. Eur J Orthod. 2017;39(2):176–187.

Baumrind S, Korn EL, Isaacson RJ, West EE, Molthen R. Quantitative analysis

of the orthodontic and orthopedic effects of maxillary traction. Am J Orthod.

;84(5):384–398.

Hubbard GW, Nanda RS, Currier GF. A cephalometric evaluation of nonextraction

cervical headgear treatment in Class II malocclusions. Angle Orthod.

;64(5):359–370.

Keeling SD, Wheeler TT, King GJ, Garvan CW, Cohen DA, Cabassa S, et al. Anteroposterior

skeletal and dental changes after early Class II treatment with bionators

and headgear. Am J Orthod Dentofac Orthop Off Publ Am Assoc Orthod Its Const

Soc Am Board Orthod. 1998;113(1):40–50.

Ulger G, Arun T, Sayinsu K, Isik F. The role of cervical headgear and lower utility

arch in the control of the vertical dimension. Am J Orthod Dentofac Orthop Off

Publ Am Assoc Orthod Its Const Soc Am Board Orthod. 2006;130(4):492–501.

Higgins J, Green S. .Manual Cochrane de revisiones sistemáticas de intervenciones.

versión 5.1.0. Oxford; 2011.

Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ, et al. Assessing

the quality of reports of randomized clinical trials: is blinding necessary? Control

Clin Trials. 1996;17(1):1–12.

Shea BJ, Bouter LM, Peterson J, Boers M, Andersson N, Ortiz Z, et al. External

validation of a measurement tool to assess systematic reviews (AMSTAR). PLoS

ONE. 2007;2(12):e1350.

Berra S, Elorza-Ricart JM, Estrada M-D, Sánchez E. [A tool (corrected) for the

critical appraisal of epidemiological cross-sectional studies]. Gac Sanit SESPAS.

;22(5):492–497.

Alió-Sanz J, Iglesias-Conde C, Lorenzo-Pernía J, Iglesias-Linares A, Mendoza-

Mendoza A, Solano-Reina E. Effects on the maxilla and cranial base caused

by cervical headgear: a longitudinal study. Med Oral Patol Oral Cirugía Bucal.

;17(5):e845–851.

Bondemark L, Karlsson I. Extraoral vs intraoral appliance for distal movement

of maxillary first molars: a randomized controlled trial. Angle Orthod.

;75(5):699–706.

Godt A, Kalwitzki M, Göz G. Retrospective analysis of casts to assess cervical

headgear treatment in the presence of vertical growth pattern. J Orofac Orthop

Fortschritte Kieferorthopädie OrganOfficial J Dtsch Ges Für Kieferorthopädie.

;66(3):230–240.

Godt A, Kalwitzki M, Göz G. Effects of cervical headgear on overbite against the

background of existing growth patterns. A retrospective analysis of study casts.

Angle Orthod. 2007;77(1):42–46.

Godt A, Berneburg M, Kalwitzki M, Göz G. Cephalometric analysis of molar and anterior

tooth movement during cervical headgear treatment in relation to growth

patterns. J Orofac Orthop Fortschritte Kieferorthopädie OrganOfficial J Dtsch Ges

Für Kieferorthopädie. 2008;69(3):189–200.

Kirjavainen M, Kirjavainen T, Haavikko K. Changes in dental arch dimensions

by use of an orthopedic cervical headgear in Class II correction. Am J Orthod

Dentofac Orthop Off Publ Am Assoc Orthod Its Const Soc Am Board Orthod.

;111(1):59–66.

Kirjavainen M, Kirjavainen T. Maxillary expansion in Class II correction with orthopedic

cervical headgear. A posteroanterior cephalometric study. Angle Orthod.

;73(3):281–285.

Kirjavainen M, Hurmerinta K, Kirjavainen T. Facial profile changes in early Class II

correction with cervical headgear. Angle Orthod. 2007;77(6):960–967.

Kopecky GR, Fishman LS. Timing of cervical headgear treatment based on skeletal

maturation. Am J Orthod Dentofac Orthop Off Publ Am Assoc Orthod Its Const Soc

Am Board Orthod. 1993;104(2):162–169.

Lima Filho RMA, Lima AL, de Oliveira Ruellas AC. Mandibular changes in skeletal

class II patients treated with Kloehn cervical headgear. Am J Orthod Dentofac Orthop

Off Publ Am Assoc Orthod Its Const Soc Am Board Orthod. 2003;124(1):83–90.

Lima Filho RMA, Lima AL, de Oliveira Ruellas AC. Longitudinal study of anteroposterior

and vertical maxillary changes in skeletal class II patients treated with

Kloehn cervical headgear. Angle Orthod. 2003;73(2):187–193.

Lione R, Franchi L, Laganà G, Cozza P. Effects of cervical headgear and pendulum

appliance on vertical dimension in growing subjects: a retrospective controlled

clinical trial. Eur J Orthod. 2015;37(3):338–344.

Mäntysaari R, Kantomaa T, Pirttiniemi P, Pykäläinen A. The effects of early headgear

treatment on dental arches and craniofacial morphology: a report of a 2 year

randomized study. Eur J Orthod. 2004;26(1):59–64.

Melsen B, Dalstra M. Distal molar movement with Kloehn headgear: is it stable?

Am J Orthod Dentofac Orthop Off Publ Am Assoc Orthod Its Const Soc Am Board

Orthod. 2003;123(4):374–378.

Varlik SK, Iscan HN. The effects of cervical headgear with an expanded inner bow

in the permanent dentition. Eur J Orthod. 2008;30(4):425–430.

Kloehn SJ. Evaluation Of Cervical Anchorage Force In Treatment. Angle Orthod.

;31(2):91–104.

King EW. Cervical Anchorage in Class II, Division I Treatment, A Cephalometric

Appraisal. Angle Orthod. 1957;27(2):98–104.

Tulloch JF, Phillips C, Koch G, Proffit WR. The effect of early intervention on

skeletal pattern in Class II malocclusion: a randomized clinical trial. Am J Orthod

Dentofac Orthop Off Publ Am Assoc Orthod Its Const Soc Am Board Orthod.

;111(4):391–400.

Hunter CJ. The correlation of facial growth with body height and skeletal maturation

at adolescence. Angle Orthod. 1966;36(1):44–54.

Yepes E, Quintero P, Rueda ZV, Pedroza A. Optimal force for maxillary protraction

facemask therapy in the early treatment of class III malocclusion. Eur J Orthod.

;36(5):586–594.

Cook AH, Sellke TA, BeGole EA. Control of the vertical dimension in Class II correction

using a cervical headgear and lower utility arch in growing patients.

Part I. Am J Orthod Dentofac Orthop Off Publ Am Assoc Orthod Its Const Soc Am

Board Orthod. 1994;106(4):376–388.

Brown P. A cephalometric evaluation of high-pull molar headgear and face-bow

neck strap therapy. Am J Orthod. 1978;74(6):621–632.

Boecler PR, Riolo ML, Keeling SD, TenHave TR. Skeletal changes associated with

extraoral appliance therapy: an evaluation of 200 consecutively treated cases.

Angle Orthod. 1989;59(4):263–270.

Boatwright P. Single arch treatment with the Kloehn headgear: A cephalometric

evaluation. [unpublished Master’s Thesis]. Department of Orthodontics, St. Louis

University;; 1968.

Cangialosi TJ, Meistrell ME, Leung MA, Ko JY. A cephalometric appraisal of edgewise

Class II nonextraction treatment with extraoral force. Am J Orthod Dentofac Orthop

Off Publ Am Assoc Orthod Its Const Soc Am Board Orthod. 1988;93(4):315–324.

Ghafari J, Shofer FS, Jacobsson-Hunt U, Markowitz DL, Laster LL. Headgear versus

function regulator in the early treatment of Class II, division 1 malocclusion:

a randomized clinical trial. Am J Orthod Dentofac Orthop Off Publ Am Assoc

Orthod Its Const Soc Am Board Orthod. 1998;113(1):51–61.




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