Dentoskeletal effects of the Bite-Jumping Appliance and the Twin-Block Appliance in the treatment of skeletal Class II malocclusion: a randomized controlled trial

Abstract

Objectives: The current parallel group, randomized controlled trial aimed to compare the dentoalveolar and skeletal changes resulting from treatment using two popular functional appliances: the Bite-Jumping Appliance (BJA) and the Twin-Block Appliance (TBA).Study design: This study is designed as a parallel-group, randomized controlled trial.Materials and methods: Patients were screened from the patients who were seeking treatment atthe Department of Orthodontics, Al-Baath University. Eligibility criteria included skeletal Class IIdivision 1 malocclusion resulting from the retrusion of the mandible. A computer-generatedrandomization list was used to randomly divide the patients into two equal groups to be treatedwith either the BJA or the TBA. Blinding was applicable for outcome assessment only. Fortyfourpatients (22 male and 22 female) aged 10.2-13.5 years were randomized in a 1:1 ratio toeither the BJA or the TBA groups, and four patients were lost to follow-up (two from each group).Lateral cephalometric radiographs were obtained before treatment and after 12 months of activeappliance therapy. Inter-group differences were evaluated with two-sample t-tests, and intra-groupdifferences were assessed with paired-sample t-tests at the P <0.05 level.Results: Forty patients (20 in each group) were available for the statistical analysis. Baselinecharacteristics were similar between groups. Similar changes were observed in the sagittalplane, including a significant increase in the SNB angle. No significant changes were observedin the maxilla. The lower incisors were significantly proclined, and the upper incisors significantlyretruded. In the vertical plane, BJA induced mandibular clockwise rotation, and the SN:MP angleincreased by 2.14 ± 2.97° (P = 0.002). Conversely, no significant changes took place in this angle inthe TBA group 0.75 ± 2.37 (P = 0.096). Similarly, Jarabak ratio decreased significantly in the BJAgroup by -1.78 ± 0.85% (P = 0.002) and increased significantly in the TBA group by 1.26 ± 0.76%(P = 0.032), with significant differences between the two groups (P = 0.001). No serious harm wasobserved.Limitations: A limitation of this research is a lack of an untreated control group. However, the resulting differences between the two groups can be attributed to the appliance differences, which fulfil the aim of the current research. Conclusions: Each of the two appliances is recommended for the functional treatment of skeletal Class II malocclusion resulting from the retrusion of the mandible. The BJA is recommended when clockwise rotation is desired, whereas the TBA is recommended to inhibit vertical development.