Evaluation of the posterior airway space following orthopaedic treatment of mandibular deficient Class II malocclusion – a pilot study


Share / Export Citation / Email / Print / Text size:

Australasian Orthodontic Journal

Australian Society of Orthodontists

Subject: Dentistry, Orthodontics & Medicine


ISSN: 2207-7472
eISSN: 2207-7480





Volume / Issue / page

Volume 38 (2022)
Volume 37 (2021)
Volume 36 (2020)
Volume 35 (2019)
Volume 34 (2018)
Volume 33 (2017)
Volume 32 (2016)
Volume 31 (2015)
Related articles

VOLUME 34 , ISSUE 1 (May 2018) > List of articles

Evaluation of the posterior airway space following orthopaedic treatment of mandibular deficient Class II malocclusion – a pilot study

Christopher J. Costello / John Sambevski / Lam L. Cheng / M. Ali Darendeliler *

Citation Information : Australasian Orthodontic Journal. Volume 34, Issue 1, Pages 11-16, DOI: https://doi.org/10.21307/aoj-2020-054

License : (CC BY 4.0)

Published Online: 20-July-2021



Background: The use of Twin Block therapy is a well-accepted functional treatment option for the correction of a Class II malocclusion. In addition to skeletal and dental changes, its use may also promote changes in airway structure and dimension, including the size of the posterior airway space (PAS). This may be of importance in reducing the risk of developing obstructive sleep apnoea syndrome (OSAS).

Materials and methods: Sixteen (16) subjects (eight females and eight males) underwent treatment of a Class II division 1 malocclusion via the use of a Sydney Bonded Twin Block (SBTB) appliance followed by full fixed orthodontic therapy (FFOA). Pretreatment (T1), post-twin block (T2) and post-fixed appliance (T3) lateral cephalograms were taken and skeletal and soft tissue landmarks were hand traced. A pairwise comparison was used to assess whether there were any significant differences in the cephalometric variables between each phase of treatment (T1, T2, T3).

Results: The skeletal variables SNB and ANB revealed a significant change between T1-T2 (p < 0.01). The sagittal size of the nasopharynx (RPAS) also recorded a significant change between T1-T3 (p < 0.05). There was no significant change in the PAS at any stage of treatment. There was an average reduction in the ANB angle of 2° (p < 0.01) between T1-T3.

Conclusions: There was no significant change in the size of the PAS following SBTB treatment. However, an increase in RPAS was recorded following SBTB treatment which continued to improve during FFOA therapy.

Content not available PDF Share



1. Tangugsorn V, Skatvedt O, Krogstad O, Lyberg T. Obstructive sleep apnoea: a cephalometric study. Part I. Cervico-craniofacial skeletal morphology. Eur J Orthod 1995;17:45-56.

2. Athanasiou AE, Papadopoulos MA, Mazaheri M, Lagoudakis M. Cephalometric evaluation of pharynx, soft palate, adenoid tissue, tongue, and hyoid bone following the use of a mandibular repositioning appliance in obstructive sleep apnea patients. Int J Adult Orthodon Orthognath Surg 1994;9:273-83.

3. Schmidt-Nowara WW, Meade TE, Hays MB. Treatment of snoring and obstructive sleep apnea with a dental orthosis. Chest 1991;99:1378-85.

4. Villa MP, Bernkopf E, Pagani J, Broia V, Montesano M, Ronchetti R. Randomized controlled study of an oral jaw-positioning appliance for the treatment of obstructive sleep apnea in children with malocclusion. Am J Respir Crit Care Med 2002;165:123-7.

5. Pirsig W, Verse T. Long-term results in the treatment of obstructive sleep apnea. Eur Arch Otorhinolaryngol 2000;257:570-7.

6. Clark WJ. The twin block technique. A functional orthopedic appliance system. Am J Orthod Dentofacial Orthop 1988;93:1-18.

7. Gill D, Sharma A, Naini F, Jones S. The twin block appliance for the correction of Class II malocclusion. Dent Update 2005;32:158-60, 63-4, 67-8.

8. Clark W. The twin block technique. Funct Orthod 1990;7:24-8, 31.

9. Clark WJ. The twin block traction technique. Eur J Orthod 1982;4:129-38.

10. Muto T, Yamazaki A, Takeda S. A cephalometric evaluation of the pharyngeal airway space in patients with mandibular retrognathia and prognathia, and normal subjects. Int J Oral Maxillofac Surg 2008;37:228-31.

11. DePonte F, Sassano P, Gennaro P, Pascali M, Marchetti E. Obstructive sleep apnea in a growing patient. J Craniofac Surg 1999;10:430-4.

12. Trenouth MJ, Timms DJ. Relationship of the functional oropharynx to craniofacial morphology. Angle Orthod 1999;69:419-23.

13. Solow B, Skov S, Ovesen J, Norup PW, Wildschiødtz G. Airway dimensions and head posture in obstructive sleep apnoea. Eur J Orthod 1996;18:571-9.

14. Kinzinger G, Czapka K, Ludwig B, Glasl B, Gross U, Lisson J. Effects of fixed appliances in correcting Angle Class II on the depth of the posterior airway space: FMA vs. Herbst appliance--a retrospective cephalometric study. J Orofac Orthop 2011;72:301-20.

15. Ozbek MM, Memikoglu TU, Gögen H, Lowe AA, Baspinar E. Oropharyngeal airway dimensions and functional-orthopedic treatment in skeletal Class II cases. Angle Orthod 1998;68:327-36.

16. Singh GD, Garcia-Motta AV, Hang WM. Evaluation of the posterior airway space following Biobloc therapy: geometric morphometrics. Cranio 2007;25:84-9.

17. Carvalho FR, Lentini-Oliveira D, Machado MA, Prado GF, Prado LB, Saconato H. Oral appliances and functional orthopaedic appliances for obstructive sleep apnoea in children. Cochrane Database Syst Rev 2007:CD005520.

18. Villa MP, Miano S, Rizzoli A. Mandibular advancement devices are an alternative and valid treatment for pediatric obstructive sleep apnea syndrome. Sleep Breath 2012;16:971-6.

19. Li L, Liu H, Cheng H, Han Y, Wang C, Chen Y et al. CBCT evaluation of the upper airway morphological changes in growing patients of class II division 1 malocclusion with mandibular retrusion using twin block appliance: a comparative research. PLoS One 2014;9:e94378.

20. Hourfar J, Kinzinger GS, Meißner LK, Lisson JA. Effects of two different removable functional appliances on depth of the posterior airway space : A retrospective cephalometric study. J Orofac Orthop 2017;78:166-75.

21. Bohlman ME, Haponik EF, Smith PL, Allen RP, Bleecker ER, Goldman SM. CT demonstration of pharyngeal narrowing in adult obstructive sleep apnea. AJR Am J Roentgenol 1983;140:543-8.

22. Pae EK, Lowe AA, Sasaki K, Price C, Tsuchiya M, Fleetham JA. A cephalometric and electromyographic study of upper airway structures in the upright and supine positions. Am J Orthod Dentofacial Orthop 1994;106:52-9.

23. Robertson CJ. The effect of long-term mandibular advancement on the hyoid bone and pharynx as it relates to the treatment of obstructive sleep apnoea. Aust Orthod J 2000;16:157-66.