Three-dimensional cone-beam computed technology evaluation of skeletal and dental changes in growing patients with Class II malocclusion treated with the cervical pull face-bow headgear appliance

This study aimed to 3-dimensionally quantify and compare the outcomes of growing patients with Class II malocclusion treated with the cervical pull face-bow headgear appliance in combination with full fixed orthodontic appliances.The study sample consisted of 22 patients with Class II malocclusion with the following inclusion criteria: ANB >4.75°, Class II molar relationship, and SN-GoGn <37°. The mean age of patients was 12.5 ± 1.1 years at baseline. The average treatment time was 27.7 ± 7.3 months. Cone-beam computed tomography scans were superimposed in the cranial base, maxillary regional, and mandibular regional to evaluate growth, treatment displacements, and bone remodeling.Relevant statistically and clinically significant skeletal changes included average decreases in ANB (2.1 ± 1.1°) and SNA (1.8 ± 1.1°); posterior (1.3 ± 1.4 mm) and inferior (4.6 ± 2.2 mm) displacement of A-point; inferior displacements of B-point (5.4 ± 2.8 mm) and Pogonion (5.8 ± 2.6 mm); superior displacement of Condylion (6.9 ± 2.4 mm); increase in mandibular length (5.4 ± 2.0 mm); and clockwise rotation of palatal plane (1.9 ± 1.9°). Significant proclination of the maxillary incisors (9.8 ± 11.1°) and nonsignificant proclination of the mandibular incisors (4.7 ± 9.6°) were also noted.Class II skeletal correction was primarily achieved by posterior, inferior displacement of the sagittal position of the maxilla. Change in the sagittal position of the mandible/chin (B-point, Pogonion) was not significant; rather, mandibular displacement was significant in an inferior vertical direction without backward rotation, as seen from marked condylar and ramus growth.