The skeletal and dental effects of Hanks Herbst versus twin block appliances for class II correction in growing patients: a randomized clinical trial

BACKGROUND

Despite the popularity of the Twin Block (TB) and the Hanks Herbst (HH) functional appliances, there is limited prospective research comparing these removable and fixed designs, respectively.

OBJECTIVES

To evaluate and compare the skeletal and dental effects associated with TB and HH functional appliances as well as to detect factors that might influence the success or failure of treatment in adolescents with Class II malocclusion.

DESIGN AND SETTING

A parallel-group randomized controlled trial was undertaken in a single-centre hospital in the United Kingdom.

METHODS

A total of 80 participants (aged 10-14 years) with overjet of 7 mm or more were randomized to receive either the HH or TB appliance. Cephalometric radiographs were collected at the start of the study and immediately after the withdrawal of the functional appliances and measured using Pancherz analysis. Participants were allocated to the TB or HH group, based on an electronic randomization, stratified for gender and allocation concealed. Blinding to the allocated arm was not possible. However, all data were coded and anonymized to ensure that assessors were blinded to the group allocation. The main outcome was the anterior-posterior skeletal and dento-alveolar changes at the end of the functional phase.

RESULTS

Fifteen (37.5%) participants from the TB group and 7 (15.5%) from HH failed to achieve full overjet reduction (<4 mm) after 12 months of treatment. Overjet reduction was 2 mm greater with HH compared to TB (P = .05; 95% CI: 0.2, 3.2). No significant differences regarding skeletal and dental changes were reported, with the exception that participants in HH group experienced greater lower molar protraction (P = .002; 95% CI: -2.8, -0.8) and mandibular incisors advancement (P = .001; 95% CI: -2.9, -1), indicating greater dental than skeletal effects.

CONCLUSION

The TB appliance was associated with a higher rate of treatment discontinuation. No significant clinical differences were observed in the skeletal and dental effects, although the HH may be associated with more pronounced effects on the mandibular dentition.

CLINICAL TRIAL REGISTRATION

The protocol was registered online before the start of the trial (ISRCTN11717011).

Long-term comparison of the efficacy of manual versus powered tooth brushing in adolescent orthodontic patients: a single-centre, parallel design randomized clinical trial

BACKGROUND AND OBJECTIVES

To-date, there is no evidence comparing the long-term efficacy of powered and manual toothbrushes in adolescents undergoing fixed appliance treatment. The trial compared the efficacy of manual versus powered toothbrush in controlling plaque and gingival health in patients undergoing fixed treatment in respect of both the short- and long-term.

TRIAL DESIGN

This was a randomized, parallel, controlled single-blind clinical trial, undertaken in a hospital setting, for which the consolidated standards of reporting trials guidelines were followed.

METHODS

Ninety-two adolescent participants planned to undergo fixed appliance therapy, were randomly assigned to either a manual or powered toothbrush, with allocation concealment. The outcome measures were plaque and gingival indices and bleeding on probing, assessed at baseline (prior to fixed appliance), one-, six- and 12-months.

RESULTS

The final sample included 84 participants, aged 12-18 (M=14.1, SD=1.93) years, with 40 (47%) were using a manual and 44 (52%) a powered toothbrush. The intervention (powered vs. manual toothbrush) itself appeared insignificant with regards to the gingival index (GI) (95%CI -0.1 - 0.03; P=0.26), plaque index (PI) (95%CI -0.13 - 0.14; P=0.93) and bleeding on probing (BoP) (95%CI -0.03 - 0.03; P=0.98) at any of the time points assessed. However, periodontal health indicators and plaque control significantly worsened (p<0.01), over the 12-month follow-up period, following placement of the fixed appliances placement.

CONCLUSION

Whilst no differences were found between manual and powered toothbrushes in controlling plaque and gingival health, in participants undergoing fixed orthodontic treatment, both were suboptimal and highlighted the need for greater patient support and monitoring.

TRIAL REGISTRATION DETAILS

https://doi.org/10.1186/ISRCTN74268923 Trial funding: Colgate-Palmolive (USA).

The use of the Hanks Herbst vs Twin-block in Class II malocclusion: A randomized controlled trial

INTRODUCTION

This 2-arm parallel study aimed to compare and evaluate the efficiency of Hanks Herbst (HH) and Twin-block (TB) functional appliances in treating adolescents with Class II malocclusion.

METHODS

A parallel-group randomized controlled trial was undertaken in a single United Kingdom hospital. Eighty participants were recruited and randomized in a 1:1 ratio to receive either the HH or TB appliance. Eligibility criteria included children aged 10-14 years with an overjet of ≥7 mm without dental anomalies. The primary outcome was the time (in months) required to reduce overjet to normal limits (<4 mm). Secondary outcomes included treatment failure rates, complications and their impact on oral health-related quality of life (OHRQOL). Randomization was accomplished using electronic software with allocation concealed using sequentially numbered, opaque, and sealed envelopes. Blinding was only applicable for outcome assessment. Data were analyzed using descriptive statistics and regression analyses to detect between-group differences, including Cox regression for time to treatment success.

RESULTS

HH was significantly faster than TB in reducing the overjet to within normal limits (95% confidence interval [CI], -3.00 to -0.03; P = 0.046). Mean overjet reduction was more efficient with the HH than the TB appliance (ß = 1.3; 95% CI, 0.04-2.40; P = 0.04). Fifteen (37.5%) of the participants in the TB group and 7 (17.5%) in the HH group failed to complete the treatment (hazard ratio = 0.54; 95% CI, 0.32-0.91, P = 0.02). However, TB was associated with fewer routine (incidence rate ratio = 0.81; 95% CI, 0.7-0.9; P = 0.004) and emergency (incidence rate ratio = 0.1; 95% CI, 0.1-0.3; P = 0.001) visits. Chairside time was greater with the HH (ß = 2.7; 95% CI, 1.8-3.6, P = 0.001). Participants in both groups experienced complications with similar frequency. A greater deterioration in OHRQOL was found during treatment with the TB.

CONCLUSIONS

Treatment with HH resulted in more efficient and predictable overjet reduction than TB. More treatment discontinuation and greater deterioration in OHRQOL were observed with the TB. However, HH was associated with more routine and emergency visits.

REGISTRATION

ISRCTN11717011.

PROTOCOL

The protocol was not published before trial commencement.

FUNDING

No specific external or internal funding was provided. Treatment for participants was provided as part of routine orthodontic treatment in the hospital.