{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T01:33:23Z","timestamp":1790127203633,"version":"4.0.1"},"reference-count":44,"publisher":"The Angle Orthodontist (EH Angle Education & Research Foundation)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2010,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n        <jats:p>\n          <jats:bold>Objective:<\/jats:bold> 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.<\/jats:p>\n        <jats:p>\n          <jats:bold>Materials and Methods:<\/jats:bold> 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 T<jats:sub>1<\/jats:sub> (initial records), T<jats:sub>2<\/jats:sub> (completion of functional therapy), and T<jats:sub>3<\/jats:sub> (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.<\/jats:p>\n        <jats:p>\n          <jats:bold>Results:<\/jats:bold> (1) Temporary restriction of maxillary growth was found in the MARA group (T<jats:sub>2<\/jats:sub>\u2013T<jats:sub>1<\/jats:sub>). (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.<\/jats:p>\n        <jats:p>\n          <jats:bold>Conclusions:<\/jats:bold> No significant dentoskeletal differences were observed long-term, among the various treatment groups and matched controls.<\/jats:p>","DOI":"10.2319\/020109-11.1","type":"journal-article","created":{"date-parts":[[2009,10,15]],"date-time":"2009-10-15T01:00:59Z","timestamp":1255568459000},"page":"18-29","source":"Crossref","is-referenced-by-count":63,"title":["Long-Term Dentoskeletal Changes with the Bionator, Herbst, Twin Block, and MARA Functional Appliances"],"prefix":"10.2319","volume":"80","author":[{"given":"Nicole J.","family":"Siara-Olds","sequence":"first","affiliation":[{"name":"Private Practice, Warren, Mich"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valmy","family":"Pangrazio-Kulbersh","sequence":"additional","affiliation":[{"name":"Private Practice, Sterling Heights, Mich, Adjunct Professor, Department of Orthodontics, University of Detroit Mercy, Detroit, Mich"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeff","family":"Berger","sequence":"additional","affiliation":[{"name":"Private Practice, Windsor, ON, Canada, Adjunct Professor, Department of Orthodontics, University of Detroit Mercy, Detroit, Mich"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Burcu","family":"Bayirli","sequence":"additional","affiliation":[{"name":"Associate Professor, Department of Orthodontics, University of Detroit Mercy, Detroit, Mich"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1164","reference":[{"key":"i0003-3219-80-1-18-b01","series-title":"Contemporary Orthodontics. 3rd edition","first-page":"13","author":"Proffit, W. 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Stability or relapse?","volume":"104","author":"Wieslander, L.","year":"1993","unstructured":"Wieslander, L.\n          \n          Long-term effect of treatment with the headgear-Herbst appliance in the early mixed dentition. Stability or relapse?\n          Am J Orthod Dentofacial Orthop\n          1993. 104:319\u2013329."},{"key":"i0003-3219-80-1-18-b16","series-title":"Am J Orthod Dentofacial Orthop","first-page":"9","article-title":"Effectiveness of early treatment of Class II malocclusion.","volume":"121","author":"Wheeler, T. T.","year":"2002","unstructured":"Wheeler, T. T., S. P.McGorray, M. G.Taylor, and G. L.King. Effectiveness of early treatment of Class II malocclusion.Am J Orthod Dentofacial Orthop2002. 121:9\u201317."},{"key":"i0003-3219-80-1-18-b17","series-title":"Am J Orthod Dentofacial Orthop","first-page":"596","article-title":"Skeletal Class II patterns in the primary dentition.","volume":"121","author":"Klocke, A.","year":"2002","unstructured":"Klocke, A., R. S.Nanda, and B.Kahl-Nieke. Skeletal Class II patterns in the primary dentition.Am J Orthod Dentofacial Orthop2002. 121:596\u2013601."},{"key":"i0003-3219-80-1-18-b18","series-title":"Am J Orthod Dentofacial Orthop","first-page":"191","article-title":"Treatment effects of headgear biteplane and bionator appliances.","volume":"132","author":"Almeida-Pedrin, R. R.","year":"2007","unstructured":"Almeida-Pedrin, R. R., M. R.Almeida, R. R.Almeida, A.Pinzan, and F. P. C.Ferreira. Treatment effects of headgear biteplane and bionator appliances.Am J Orthod Dentofacial Orthop2007. 132:191\u2013198."},{"key":"i0003-3219-80-1-18-b19","series-title":"Eur J Orthod","first-page":"65","article-title":"Treatment effects produced by the Bionator appliance. Comparison with an untreated Class II sample.","volume":"26","author":"Almeida, M. R.","year":"2004","unstructured":"Almeida, M. R., J. F. C.Henriques, R. R.Almeida, R. R.Almeida-Pedrin, and W.Ursi. 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Mandibular response to orthodontic treatment with the Bionator appliance.Am J Orthod Dentofacial Orthop1990. 97:113\u2013120."},{"key":"i0003-3219-80-1-18-b21","series-title":"Am J Orthod Dentofacial Orthop","first-page":"437","article-title":"\u201cEffective condylar growth\u201d and chin position changes in Herbst treatment: a cephalometric roentgenographic long-term study.","volume":"114","author":"Pancherz, H.","year":"1998","unstructured":"Pancherz, H., S.Ruf, and P.Kohlhas. \u201cEffective condylar growth\u201d and chin position changes in Herbst treatment: a cephalometric roentgenographic long-term study.Am J Orthod Dentofacial Orthop1998. 114:437\u2013446."},{"key":"i0003-3219-80-1-18-b22","series-title":"Am J Orthod Dentofacial Orthop","first-page":"451","article-title":"Long-term comparison of treatment outcome and stability of Class II patients treated with functional appliances versus bilateral sagittal split ramus osteotomy.","volume":"127","author":"Berger, J. L.","year":"2005","unstructured":"Berger, J. L., V.Pangrazio-Kulbersh, C.George, and R.Kaczynski. Long-term comparison of treatment outcome and stability of Class II patients treated with functional appliances versus bilateral sagittal split ramus osteotomy.Am J Orthod Dentofacial Orthop2005. 127:451\u2013464."},{"key":"i0003-3219-80-1-18-b23","series-title":"Am J Orthod Dentofacial Orthop","first-page":"31","article-title":"Efficiency of early and late Class II division 1 treatment.","volume":"121","author":"von Bremen, J.","year":"2002","unstructured":"von Bremen, J. and H.Pancherz. Efficiency of early and late Class II division 1 treatment.Am J Orthod Dentofacial Orthop2002. 121:31\u201337."},{"key":"i0003-3219-80-1-18-b24","series-title":"Am J Orthod","first-page":"423","article-title":"Treatment of Class II malocclusions by jumping the bite with the Herbst appliance. A cephalometric investigation.","volume":"76","author":"Pancherz, H.","year":"1979","unstructured":"Pancherz, H.\n          \n          Treatment of Class II malocclusions by jumping the bite with the Herbst appliance. A cephalometric investigation.\n          Am J Orthod\n          1979. 76:423\u2013442."},{"key":"i0003-3219-80-1-18-b25","series-title":"Am J Orthod Dentofacial Orthop","first-page":"118","article-title":"A comparison of one-stage and two-stage nonextraction alterations in matched Class II samples.","volume":"108","author":"Livieratos, F. A.","year":"1995","unstructured":"Livieratos, F. A. and L. E.Johnston. 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J.\n          \n          Proportional changes in cephalometric distances during Twin Block appliance therapy.\n          Eur J Orthod\n          2002. 24:485\u2013491."},{"key":"i0003-3219-80-1-18-b32","series-title":"Euro J Orthod","first-page":"501","article-title":"A prospective evaluation of Bass, Bionator and Twin Block appliances. Part I\u2014the hard tissues.","volume":"20","author":"Illing, H. M.","year":"1998","unstructured":"Illing, H. M., D. O.Morris, and R. T.Lee. A prospective evaluation of Bass, Bionator and Twin Block appliances. Part I\u2014the hard tissues.Euro J Orthod1998. 20:501\u2013516."},{"key":"i0003-3219-80-1-18-b33","series-title":"Angle Orthod","first-page":"410","article-title":"Cephalometric determinants of successful functional appliance therapy.","volume":"72","author":"Patel, H. P.","year":"2002","unstructured":"Patel, H. P., H. C.Moseley, and J. H.Noar. Cephalometric determinants of successful functional appliance therapy.Angle Orthod2002. 72:410\u2013417."},{"key":"i0003-3219-80-1-18-b34","series-title":"Am J Orthod Dentofacial Orthop","first-page":"286","article-title":"Treatment effects of the mandibular anterior repositioning appliance on patients with Class II malocclusion.","volume":"123","author":"Pangrazio-Kulbersh, V.","year":"2003","unstructured":"Pangrazio-Kulbersh, V., J. L.Berger, D. S.Chermak, R.Kaczynski, E. S.Simon, and A.Haerian. Treatment effects of the mandibular anterior repositioning appliance on patients with Class II malocclusion.Am J Orthod Dentofacial Orthop2003. 123:286\u2013295."},{"key":"i0003-3219-80-1-18-b35","series-title":"Am J Orthod Dentofacial Orthop","first-page":"220","article-title":"The nature of Class II relapse after Herbst appliance treatment: a cephalometric long-term investigation.","volume":"100","author":"Pancherz, H.","year":"1991","unstructured":"Pancherz, H.\n          \n          The nature of Class II relapse after Herbst appliance treatment: a cephalometric long-term investigation.\n          Am J Orthod Dentofacial Orthop\n          1991. 100:220\u2013233."},{"key":"i0003-3219-80-1-18-b36","series-title":"Angle Orthod","first-page":"170","article-title":"Skeletal changes of Herbst appliance therapy investigated with more conventional cephalometrics and European norms.","volume":"71","author":"Manfredi, C.","year":"2001","unstructured":"Manfredi, C., R.Cimino, A.Trani, and H.Pancherz. Skeletal changes of Herbst appliance therapy investigated with more conventional cephalometrics and European norms.Angle Orthod2001. 71:170\u2013176."},{"key":"i0003-3219-80-1-18-b37","series-title":"Eur J Orthod","first-page":"375","article-title":"Temporomandibular joint growth adaptation in Herbst treatment: a prospective magnetic resonance imaging and cephalometric roentgenographic study.","volume":"20","author":"Ruf, S.","year":"1998","unstructured":"Ruf, S. and H.Pancherz. Temporomandibular joint growth adaptation in Herbst treatment: a prospective magnetic resonance imaging and cephalometric roentgenographic study.Eur J Orthod1998. 20:375\u2013388."},{"key":"i0003-3219-80-1-18-b38","series-title":"Am J Orthod","first-page":"585","article-title":"Prediction of mandibular growth rotation.","volume":"55","author":"Bjork, A.","year":"1969","unstructured":"Bjork, A.\n          \n          Prediction of mandibular growth rotation.\n          Am J Orthod\n          1969. 55:585\u2013599."},{"key":"i0003-3219-80-1-18-b39","series-title":"Angle Orthod","first-page":"36","article-title":"The rotation of the mandible resulting from growth: its implications in orthodontic treatment.","volume":"35","author":"Schudy, F. F.","year":"1965","unstructured":"Schudy, F. 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A.McNamaraJr. Mandibular growth as related to cervical vertebral maturation and body height.Am J Orthod Dentofacial Orthop2000. 118:335\u2013340."},{"key":"i0003-3219-80-1-18-b44","series-title":"Orthodontics and Dentofacial Orthopedics","first-page":"75","author":"McNamara\n              Jr, J. A.","year":"2001","unstructured":"McNamara\n              Jr, J. A. and W. L.Brudon. Orthodontics and Dentofacial Orthopedics. 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