Long-Term Dentoskeletal Changes with the Bionator, Herbst, Twin Block, and MARA Functional Appliances

Abstract

Objective: To determine if the long-term dentoskeletal changes in patients treated with tooth-borne functional appliances were comparable to each other and to matched controls. Materials and Methods: The experimental sample consisted of 80 consecutively treated patients who were equally divided into Bionator, Herbst, Twin Block, and mandibular anterior repositioning appliance (MARA) groups. The control group comprised 21 children with untreated skeletal Class II malocclusions. Lateral cephalograms were taken for the treated group at T₁ (initial records), T₂ (completion of functional therapy), and T₃ (completion of fixed appliance therapy). A repeated measure analysis of variance (ANOVA) was used to assess the differences between and within groups. If ANOVA results were significant, Tukey-Kramer tests were used to determine where the significant differences occurred. Results: (1) Temporary restriction of maxillary growth was found in the MARA group (T₂–T₁). (2) SNB increased more with the Twin Block and Herbst groups when compared with the Bionator and MARA groups. (3) The occlusal plane significantly changed in the Herbst and Twin Block groups. (4) The Twin Block group expressed better control of the vertical dimension. (5) The overbite, overjet, and Wits appraisal decreased significantly with all of the appliances. (6) The Twin Block group had significant flaring of the lower incisors at the end of treatment. (7) Over the long-term, there were no significant soft tissue changes among treated and untreated subjects. Conclusions: No significant dentoskeletal differences were observed long-term, among the various treatment groups and matched controls.