Comparative assessment of tongue posture in class II division 1 patients treated with functional appliance and camouflage orthodontic treatment: a retrospective cephalometric study
DOI:
https://doi.org/10.18203/2394-6040.ijcmph20251774Keywords:
Class II malocclusion, Functional appliances, Camouflage therapy, Tongue posture, Cephalometrics, Orthodontic treatment planningAbstract
Background: Class II division 1 malocclusion is frequently associated with mandibular retrognathism, which may compromise tongue posture and airway, increasing the risk of respiratory issues. This study aimed to assess and compare the effects of functional appliance therapy and extraction-based camouflage orthodontic treatment on tongue posture in Class II division 1 patients. Limited literature exists on the impact of anterior retraction on tongue posture in skeletal Class II camouflage cases, warranting further investigation.
Methods: A retrospective cephalometric analysis was conducted on two groups: patients treated with functional appliances and those treated with premolar extractions. Pre- and post-treatment lateral cephalograms were analyzed using cephalometric parameters described by Rakosi and Lowe (tg1–tg7, tgH, tgL). Inter- and intra-group comparisons were made using the independent and dependent t-test respectively.
Results: Functional therapy showed significant improvement in total tongue length TgL intra and inter-group, suggesting enhanced oral cavity volume and forward tongue positioning. The anterior tongue dimension (Tg1) also showed significant inter-group difference. In contrast, camouflage treatment showed a significant intra-group reduction in TgL, indicating possible tongue space restriction. Other tongue posture parameters showed non-significant trends.
Conclusions: Functional appliance therapy benefits tongue posture and airway space, particularly in growing patients, by promoting mandibular and tongue advancement. In contrast, extraction-based camouflage may adversely affect tongue posture, especially in non-growing individuals. These findings emphasize the importance of airway-focused treatment planning and support the use of functional appliances when indicated.
Metrics
References
Lin TH, Hughes T, Meade MJ. The genetic and environmental contributions to variation in the permanent dental arch form: a twin study. Eur J Orthod. 2023;45(6):868-74. DOI: https://doi.org/10.1093/ejo/cjad054
Proffit WR. Equilibrium theory revisited: factors influencing position of the teeth. Angle Orthod. 1978;48(3):175-86.
Deshkar M, Thosar NR, Kabra SP, Yeluri R, Rathi NV. The influence of the tongue on the development of dental malocclusion. Cureus. 2024;16(2):61281. DOI: https://doi.org/10.7759/cureus.61281
Deregibus A, Parrini S, Domini MC, Colombini J, Castroflorio T. Analysis of tongue function from the orthodontist’s point of view: not only a matter of deglutition. Appl Sci. 2021;11(6):2520. DOI: https://doi.org/10.3390/app11062520
Shinde S, Sethi S, Vasa D, Bhosale V, Patil K, Jadhav M. Comparative cephalometric evaluation of tongue position in subjects with skeletal Class II Division 1 and Division 2 malocclusion. J Orthod Sci. 2023;12:28. DOI: https://doi.org/10.4103/jos.jos_94_22
Chhabra S, Khanna P, Munjal P, Mittal S, Arora N. Evaluation of tongue posture and dimensions in relation to skeletal Class I and Class II patterns: a cephalometric study. Int J Oral Health Dent. 2021;7(4):276-81. DOI: https://doi.org/10.18231/j.ijohd.2021.054
Rajput R, Daokar S. Comparative evaluation of hyoid bone position and tongue area with twin block and Forsus: a randomized clinical trial. Orthod J Nepal. 2020;10(1):55–64. DOI: https://doi.org/10.3126/ojn.v10i1.31006
Cohen AM, Vig PS. A serial growth study of the tongue and intermaxillary space. Angle Orthod. 1976;46(4):332–7.
Newbury DF, Monaco AP. Genetic advances in the study of speech and language disorders. Neuron. 2010;68(2):309-20. DOI: https://doi.org/10.1016/j.neuron.2010.10.001
Bourdiol P, Mishellany-Dutour A, Abou-El-Karam S, Nicolas E, Woda A. Is the tongue position influenced by the palatal vault dimensions? J Oral Rehabil. 2010;37(2):100-6. DOI: https://doi.org/10.1111/j.1365-2842.2009.02024.x
Jain I, Pradhan T, Sethia A. Evaluation of the effect of bimaxillary, mandibular setback and advancement surgeries on the pharyngeal airway space and positions of the hyoid bone, soft palate and tongue. J Orofac Sci. 2024;15:127-36. DOI: https://doi.org/10.4103/jofs.jofs_291_23
Afzal E, Fida M. Evaluation of the change in the tongue posture and in the hyoid bone position after Twin Block appliance therapy in skeletal Class II subjects. Dent Med Probl. 2019;56(4):379–84. DOI: https://doi.org/10.17219/dmp/111976
Edwards BA, Andara C, Landry S, Sands SA, Joosten SA, Owens RL, et al. Upper-airway collapsibility and loop gain predict the response to oral appliance therapy in patients with obstructive sleep apnea. Am J Respir Crit Care Med. 2016;194(11):1413-22. DOI: https://doi.org/10.1164/rccm.201601-0099OC
Ali B, Shaikh A, Fida M. Changes in oro-pharyngeal airway dimensions after treatment with functional appliance in Class II skeletal pattern. J Ayub Med Coll Abbottabad. 2015;27(4):759-63.
Duan J, Xia W, Li X, Zhang F, Wang F, Chen M, et al. Airway morphology, hyoid position and serum inflammatory markers of obstructive sleep apnea in children treated with modified twin-block appliances. BMC Oral Health. 2025;25(1):162. DOI: https://doi.org/10.1186/s12903-025-05528-y
Rakosi T. An atlas and manual of cephalometric radiography. London: Wolf Medical Publication Limited. 1978: 96–98.
Verma SK, Tandon P, Agrawal DK, Prabhat KC. A cephalometric evaluation of tongue from the rest position to centric occlusion in the subjects with Class II Division 1 malocclusion and Class I normal occlusion. J Orthodont Sci. 2012;1:34-9. DOI: https://doi.org/10.4103/2278-0203.99758
Kulshrestha R, Tandon R, Singh K, Chandra P. Analysis of pharyngeal airway space and tongue position in individuals with different body types and facial patterns: a cephalometric study. J Indian Orthod Soc. 2015;49:139-44. DOI: https://doi.org/10.1177/0974909820150304
Ganesh G, Tripathi T. Effect of fixed functional appliances on pharyngeal airway dimensions in skeletal Class II individuals: a scoping review. J Oral Biol Craniofac Res. 2021;11(4):511-23. DOI: https://doi.org/10.1016/j.jobcr.2021.07.004
Abdalla Y, Brown L, Sonnesen L. Effects of a fixed functional appliance on upper airway volume: a 3-dimensional cone-beam computed tomography study. Am J Orthod Dentofacial Orthop. 2020;158(1):40-9. DOI: https://doi.org/10.1016/j.ajodo.2019.07.013
Ozdemir F, Ulkur F, Nalbantgil D. Effects of fixed functional therapy on tongue and hyoid positions and posterior airway. Angle Orthod. 2014;84(2):260-4.
Hu Z, Yin X, Liao J, Zhou C, Yang Z, Zou S. The effect of teeth extraction for orthodontic treatment on the upper airway: a systematic review. Sleep Breath. 2015;19:441-51. DOI: https://doi.org/10.1007/s11325-015-1122-1
Pradhan T, Sethia A. Effects of various dentofacial orthopedic and orthognathic treatment modalities on pharyngeal airway. In: Intech Open; 2022. DOI: https://doi.org/10.5772/intechopen.101719
AlQahtani F, George JM, Bishawi K, Kuriadom ST. Comparison of oropharyngeal airway dimensional changes in patients with skeletal Class II and Class III malocclusions after orthognathic surgery and functional appliance treatment: a systematic review. Saudi Dent J. 2021;33(8):860-8. DOI: https://doi.org/10.1016/j.sdentj.2021.09.013
Ghoneima A, Kula K. Accuracy and reliability of cone-beam computed tomography for airway volume analysis. Eur J Orthod. 2013;35:256-61. DOI: https://doi.org/10.1093/ejo/cjr099
Chen Y, Hong L, Wang CL, Zhang SJ, Cao C, Wei F, et al. Effect of large incisor retraction on upper airway morphology in adult bimaxillary protrusion patients. Angle Orthod. 2012;82:964-70. DOI: https://doi.org/10.2319/110211-675.1
Eslami E, Katz ES, Baghdady M, Abramovitch K, Masoud MI. Are three-dimensional airway evaluations obtained through computed and cone-beam computed tomography scans predictable from lateral cephalograms. A systematic review of evidence. Angle Orthod. 2017;87:159-67. DOI: https://doi.org/10.2319/032516-243.1
Bidjan D, Sallmann R, Eliades T, Papageorgiou SN. Orthopedic treatment for Class II malocclusion with functional appliances and its effect on upper airways: a systematic review with meta-analysis. J Clin Med. 2020;9(12):3806. DOI: https://doi.org/10.3390/jcm9123806
Dedhiya N, Pradhan T, Sethia A. Assessment of airway dimensions and hyoid bone position in Class II patients treated with fixed Twin Block and Forsus Fatigue Resistant Device: a retrospective cephalometric study. J Orofac Sci. 2020;12:131-8. DOI: https://doi.org/10.4103/jofs.jofs_36_20
Lowe AA, Taka K, Yamagat Y, Sakada M. Dento skeletal and tongue son-tissue correlation. A cephalometric analysis of rest position. Am J orthod 1986;88:333-41. DOI: https://doi.org/10.1016/0002-9416(85)90133-2
Baker RE. The tongue and dental function. Am J Orthod 1954;40:927 39. DOI: https://doi.org/10.1016/S0002-9416(54)90044-5
Battagel JM, Johal A, L'Estrange PR, Croft CB, Kotecha B. Changes in airway and hyoid position in response to mandibular protrusion in subjects with obstructive sleep apnoea (OSA). Eur J Orthod. 1999;21(4):363-76. DOI: https://doi.org/10.1093/ejo/21.4.363
Kaur R, Garg AK, Gupta DK, Singla L, Aggarwal K. Effect of Twin Block therapy versus fixed functional appliances on pharyngeal airway space in skeletal Class II patients: A prospective cephalometric study. Clin Ter. 2022;173(4):306-15.
Bhatia S, Jayan B, Chopra SS. Effect of retraction of anterior teeth on pharyngeal airway and hyoid bone position in Class I bimaxillary dentoalveolar protrusion. Med J Armed Forces India. 2016;72(1):17-23. DOI: https://doi.org/10.1016/j.mjafi.2016.06.006
Kalgotra S, Mushtaq M. Position of Tongue in skeletal Class II & Class III-A Cephalometric study. IOSR J Dental Med Sci. 2016;15:33-8.
Peat JH. A cephalometric study of tongue position. Am J Orthod. 1968;54:339–51. DOI: https://doi.org/10.1016/0002-9416(68)90303-5
Fishman LS. Postural and dimensional changes in the tongue from rest position to occlusion. Angle Orthod. 1969;39:109-13.
Guay AH, Maxwell DL, Beecher R. A radiographic study of tongue posture at rest and during the phonation of /s/ in class III malocclusion. Angle Orthod. 1978;48(1):10-22.
Madhavan P. Cephalometric Evaluation of Changes in Tongue Position, Posture and Pharyngeal Airway Dimensions Following Treatment of Angle’s Class 1 Bimaxillary Proclination. Int J Multi Res Anal. 2022;5:2210-9. DOI: https://doi.org/10.47191/ijmra/v5-i8-39
Nagmode S, Yadav P, Jadhav M. Effect of first premolar extraction on point A, point B and pharyngeal airway dimension in patients with bimaxillary protrusion. J Indian Orthod Soc. 2017;51:239-44. DOI: https://doi.org/10.1177/0974909820170402
Yu M, Gao X. Tongue pressure distribution of individual normal occlusions and exploration of related factors. J Oral Rehabil. 2019;46:249–56. DOI: https://doi.org/10.1111/joor.12741
Yassaei S, Bahrololoomi Z, Sorush M. Changes of Tongue Position and Oropharynx Following Treatment with Functional Appliance. J Pediat Dentist. 2007;31(4):287-90. DOI: https://doi.org/10.17796/jcpd.31.4.lp479v346345460g
Ozbek MM, Memikoglu UT, Gogen H, Lowe A, Baspinar E. Oropharyngeal airway dimensions and functional orthopedic treatment in skeletal class II cases. Angle Orthod. 1998;68(4):327-36.
Ozbek MM, Memikoglu UT, Altug-Atac AT, Lowe AA. Stabili ty of maxillary expansion and tongue posture. Angle Orthod. 2009;79(2):214–20. DOI: https://doi.org/10.2319/010908-12.1
Ozdemir F, Ulkur F, Nalbantgil D. Effects of fixed functional therapy on tongue and hyoid positions and posterior airway. Angle Orthod. 2014;84(2):260–4. DOI: https://doi.org/10.2319/042513-319.1
Iwasaki T, Saitoh I, Takemoto Y, Inada E, Kakuno E, Kanomi R, et al. Tongue posture improvement and pharyngeal airway enlargement as secondary effects of rapid maxillary expansion: A cone-beam computed tomography study. Am J Orthod Dentofacial Orthop. 2013;143(2):235–45. DOI: https://doi.org/10.1016/j.ajodo.2012.09.014
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. DOI: https://doi.org/10.1016/S0889-5406(94)70021-4
Germec-Cakan D, Taner T, Akan S. Uvulo-glossopharyngeal dimensions in non-extraction, extraction with minimum anchorage and extraction with maximum anchorage. Eur J Orthod. 2011;33(5):515-20. DOI: https://doi.org/10.1093/ejo/cjq109
Valiathan M, El H, Hans MG, Palomo MJ. Effects of extraction versus non-extraction treatment on oropharyngeal airway volume. Angle Orthod. 2010;80(6):1068-74. DOI: https://doi.org/10.2319/010810-19.1
Sharma K, Shrivastav S, Sharma N, Hotwani K, Murrell MD. Effects of first premolar extraction on airway dimensions in young adolescents: A retrospective cephalometric appraisal. Contemp Clin Dent. 2014;5:190-4. DOI: https://doi.org/10.4103/0976-237X.132314
Downloads
Published
How to Cite
Issue
Section
