{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,31]],"date-time":"2026-01-31T05:43:53Z","timestamp":1769838233886,"version":"3.49.0"},"reference-count":25,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2019,8,23]],"date-time":"2019-08-23T00:00:00Z","timestamp":1566518400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,4,1]]},"abstract":"<jats:title>Summary<\/jats:title>\n               <jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>To assess the post-treatment changes in Class II adolescent patients treated with two different functional appliances for an extended time period.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Design<\/jats:title>\n                  <jats:p>Randomized clinical trial.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Setting<\/jats:title>\n                  <jats:p>One university and one district general hospital in the UK.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Participants<\/jats:title>\n                  <jats:p>Caucasian adolescent patients with a Class II malocclusion.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Pairs of patients of similar age and gender were randomly allocated to one of two functional appliance systems, the Twin Block or Dynamax appliance. The appliances were used for 15 months full time. Changes were measured from lateral cephalograms taken at the start (T1) and at the end of treatment at 15 months (T2) and 30 months (T3).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Hundred patients completed the trial, 52 Twin Block and 48 Dynamax. Mandibular forward movement was 3.5 mm (\u00b12.5) in the Twin Block group and 1.7 mm (\u00b12.1) in the Dynamax group (P &amp;lt; 0.01; T1\u2013T2) and, subsequently, by 0.3 mm (\u00b12.6) and 0.9 mm (\u00b12.5), respectively (P = 0.3; T2\u2013T3). Mandibular length increased by 6.3 mm (\u00b12.7) in the Twin Block group and 4.0 mm (\u00b12.5) in the Dynamax group (P &amp;lt; 0.01; T1\u2013T2) with treatment and, subsequently, by 0.5 mm (\u00b12.3) and 1.5 mm (\u00b13.1; P = 0.05). Anterior face height increased in both groups.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Treatment resulted in greater mandibular growth with the Twin Block than the Dynamax. In the follow-up period, there was less growth in the Twin Block group compared to the Dynamax<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Trial Registration<\/jats:title>\n                  <jats:p>This trial was not registered on any major database of clinical trial.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Protocol<\/jats:title>\n                  <jats:p>The protocol was not published before the commencement of the trial but can be given on request.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ejo\/cjz059","type":"journal-article","created":{"date-parts":[[2019,7,1]],"date-time":"2019-07-01T11:08:29Z","timestamp":1561979309000},"page":"135-143","source":"Crossref","is-referenced-by-count":12,"title":["Post-treatment cephalometric changes in adolescent patients with Class II malocclusion treated using two different functional appliance systems for an extended time period: a randomized clinical trial"],"prefix":"10.1093","volume":"42","author":[{"given":"Andrew T","family":"DiBiase","sequence":"first","affiliation":[{"name":"Maxillofacial Unit, East Kent Hospitals University NHS Foundation Trust, Kent"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luisa","family":"Lucchesi","sequence":"first","affiliation":[{"name":"Orthodontic Department, Dental Institute, Barts Health NHS Trust, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Usman","family":"Qureshi","sequence":"first","affiliation":[{"name":"Orthodontic Department, Dental Institute, Barts Health NHS Trust, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert T","family":"Lee","sequence":"first","affiliation":[{"name":"Maxillofacial Unit, East Kent Hospitals University NHS Foundation Trust, Kent"},{"name":"Orthodontic Department, Dental Institute, Barts Health NHS Trust, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2019,8,23]]},"reference":[{"key":"2020040104251994800_CIT0001","doi-asserted-by":"crossref","first-page":"418","DOI":"10.1093\/ejo\/cju071","article-title":"Treatment effects of removable functional appliances in patients with Class II malocclusion: a systematic review and meta-analysis","volume":"37","author":"Koretsi","year":"2015","journal-title":"European Journal of Orthodontics,"},{"key":"2020040104251994800_CIT0002","doi-asserted-by":"crossref","first-page":"657","DOI":"10.1016\/j.ajodo.2004.02.008","article-title":"Outcomes in a 2-phase randomized clinical trial of early Class II treatment","volume":"125","author":"Tulloch","year":"2004","journal-title":"American Journal of Orthodontics and Dentofacial Orthopedics,"},{"key":"2020040104251994800_CIT0003","doi-asserted-by":"crossref","first-page":"481","DOI":"10.1016\/j.ajodo.2005.08.046","article-title":"Timing of Class II treatment: skeletal changes comparing 1-phase and 2-phase treatment","volume":"132","author":"Dolce","year":"2007","journal-title":"American Journal of Orthodontics and Dentofacial Orthopedics,"},{"key":"2020040104251994800_CIT0004","doi-asserted-by":"crossref","first-page":"573","DOI":"10.1016\/j.ajodo.2007.10.042","article-title":"Early treatment for Class II Division 1 malocclusion with the Twin-block appliance: a multi-center, randomized, controlled trial","volume":"135","author":"O\u2019Brien","year":"2009","journal-title":"American Journal of Orthodontics and Dentofacial Orthopedics,"},{"key":"2020040104251994800_CIT0005","doi-asserted-by":"crossref","first-page":"465","DOI":"10.1016\/j.ajodo.2004.11.012","article-title":"Prospective clinical trial comparing the effects of conventional Twin-block and mini-block appliances: Part 1. Hard tissue changes","volume":"127","author":"Gill","year":"2005","journal-title":"American Journal of Orthodontics and Dentofacial Orthopedics,"},{"key":"2020040104251994800_CIT0006","doi-asserted-by":"crossref","first-page":"272","DOI":"10.1093\/ejo\/cjm004","article-title":"A controlled clinical trial of the effects of the Twin Block and Dynamax appliances on the hard and soft tissues","volume":"29","author":"Lee","year":"2007","journal-title":"European Journal of Orthodontics,"},{"key":"2020040104251994800_CIT0007","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1093\/ejo\/cju030","article-title":"Short-term treatment effects produced by the Twin-block appliance: a systematic review and meta-analysis","volume":"37","author":"Ehsani","year":"2015","journal-title":"European Journal of Orthodontics,"},{"key":"2020040104251994800_CIT0008","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1016\/S0889-5406(03)00150-1","article-title":"Condyle-fossa modifications and muscle interactions during Herbst treatment, Part 2. Results and conclusions","volume":"124","author":"Voudouris","year":"2003","journal-title":"American Journal of Orthodontics and Dentofacial Orthopedics,"},{"key":"2020040104251994800_CIT0009","doi-asserted-by":"crossref","first-page":"390","DOI":"10.1067\/mod.2001.112875","article-title":"Osteogenesis in the glenoid fossa in response to mandibular advancement","volume":"119","author":"Rabie","year":"2001","journal-title":"American Journal of Orthodontics and Dentofacial Orthopedics,"},{"key":"2020040104251994800_CIT0010","doi-asserted-by":"crossref","first-page":"512","DOI":"10.1093\/ejo\/cjs076","article-title":"An extended period of functional appliance therapy: a controlled clinical trial comparing the Twin Block and Dynamax appliances","volume":"36","author":"Lee","year":"2014","journal-title":"European Journal of Orthodontics,"},{"key":"2020040104251994800_CIT0011","doi-asserted-by":"crossref","first-page":"c869","DOI":"10.1136\/bmj.c869","article-title":"CONSORT 2010 explanation and elaboration: updated guidelines for reporting parallel group randomised trials","volume":"340","author":"Moher","year":"2010","journal-title":"BMJ,"},{"key":"2020040104251994800_CIT0012","first-page":"268","article-title":"The Dynamax system: a new orthopedic appliance","volume":"37","author":"Bass","year":"2003","journal-title":"Journal of Clinical Orthodontics,"},{"key":"2020040104251994800_CIT0013","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1016\/S0140-6736(86)90837-8","article-title":"Statistical methods for assessing agreement between two methods of clinical measurement","volume":"1","author":"Bland","year":"1986","journal-title":"Lancet,"},{"key":"2020040104251994800_CIT0014","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1016\/S0889-5406(03)00345-7","article-title":"Effectiveness of treatment for Class II malocclusion with the Herbst or twin-block appliances: a randomized, controlled trial","volume":"124","author":"O\u2019Brien","year":"2003","journal-title":"American Journal of Orthodontics and Dentofacial Orthopedics,"},{"key":"2020040104251994800_CIT0015","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1016\/S0889-5406(03)00352-4","article-title":"Effectiveness of early orthodontic treatment with the Twin-block appliance: a multicenter, randomized, controlled trial. Part 1: dental and skeletal effects","volume":"124","author":"O\u2019Brien","year":"2003","journal-title":"American Journal of Orthodontics and Dentofacial Orthopedics,"},{"key":"2020040104251994800_CIT0016","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1016\/S0889-5406(98)70282-3","article-title":"The effects of Twin Blocks: a prospective controlled study","volume":"113","author":"Lund","year":"1998","journal-title":"American Journal of Orthodontics and Dentofacial Orthopedics,"},{"key":"2020040104251994800_CIT0017","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1016\/0889-5406(91)70006-I","article-title":"Changes in mandibular length before, during, and after successful orthopedic correction of Class II malocclusions, using a functional appliance","volume":"99","author":"DeVincenzo","year":"1991","journal-title":"American Journal of Orthodontics and Dentofacial Orthopedics,"},{"key":"2020040104251994800_CIT0018","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1093\/ejo\/8.4.215","article-title":"Occlusal changes during and after Herbst treatment: a cephalometric investigation","volume":"8","author":"Pancherz","year":"1986","journal-title":"European Journal of Orthodontics,"},{"key":"2020040104251994800_CIT0019","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1067\/mod.2000.104902","article-title":"Posttreatment changes after successful correction of Class II malocclusions with the twin block appliance","volume":"118","author":"Mills","year":"2000","journal-title":"American Journal of Orthodontics and Dentofacial Orthopedics,"},{"key":"2020040104251994800_CIT0020","doi-asserted-by":"crossref","first-page":"598","DOI":"10.1067\/mod.2001.119801","article-title":"Dentoalveolar changes related to mandibular forward growth in untreated Class II persons","volume":"120","author":"You","year":"2001","journal-title":"American Journal of Orthodontics and Dentofacial Orthopedics,"},{"key":"2020040104251994800_CIT0021","doi-asserted-by":"crossref","first-page":"400","DOI":"10.1177\/00220345630420014701","article-title":"Variations in the growth pattern of the human mandible: longitudinal radiographic study by the implant method","volume":"42(Pt 2)","author":"Bjork","year":"1963","journal-title":"Journal of Dental Research,"},{"key":"2020040104251994800_CIT0022","first-page":"55","article-title":"Changes in dentofacial structures in untreated Class II division 1 and normal subjects: a longitudinal study","volume":"67","author":"Bishara","year":"1997","journal-title":"The Angle Orthodontist,"},{"key":"2020040104251994800_CIT0023","first-page":"36","article-title":"If wishes were horses: functional appliances and growth modification","volume":"6","author":"Johnston","year":"2005","journal-title":"Progress in Orthodontics,"},{"key":"2020040104251994800_CIT0024","doi-asserted-by":"crossref","first-page":"144.e1","DOI":"10.1016\/j.ajodo.2010.01.025","article-title":"Comparison of Twin-block and Dynamax appliances for the treatment of Class II malocclusion in adolescents: a randomized controlled trial","volume":"138","author":"Thiruvenkatachari","year":"2010","journal-title":"American Journal of Orthodontics and Dentofacial Orthopedics,"},{"key":"2020040104251994800_CIT0025","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1093\/ejo\/cju007","article-title":"Evidence of secular trends in a collection of historical craniofacial growth studies","volume":"37","author":"Antoun","year":"2015","journal-title":"European Journal of Orthodontics,"}],"container-title":["European Journal of Orthodontics"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/ejo\/article-pdf\/42\/2\/135\/32985988\/cjz059.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/ejo\/article-pdf\/42\/2\/135\/32985988\/cjz059.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,4,1]],"date-time":"2020-04-01T08:25:51Z","timestamp":1585729551000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ejo\/article\/42\/2\/135\/5553715"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,8,23]]},"references-count":25,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2019,8,23]]},"published-print":{"date-parts":[[2020,4,1]]}},"URL":"https:\/\/doi.org\/10.1093\/ejo\/cjz059","relation":{},"ISSN":["0141-5387","1460-2210"],"issn-type":[{"value":"0141-5387","type":"print"},{"value":"1460-2210","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2020,4]]},"published":{"date-parts":[[2019,8,23]]}}}