Dental and Medical Problems

Dent Med Probl
Index Copernicus (ICV 2020) – 128.41
MEiN – 70 pts
CiteScore (2021) – 2.0
JCI – 0.5
Average rejection rate (2021) – 81.35%
ISSN 1644-387X (print)
ISSN 2300-9020 (online)
Periodicity – quarterly

Download original text (EN)

Dental and Medical Problems

2020, vol. 57, nr 1, January-March, p. 53–60

doi: 10.17219/dmp/112321

Publication type: original article

Language: English

Download citation:

  • BIBTEX (JabRef, Mendeley)
  • RIS (Papers, Reference Manager, RefWorks, Zotero)

Creative Commons BY-NC-ND 3.0 Open Access

Effects of low-intensity pulsed ultrasound (LIPUS) applied on the temporomandibular joint (TMJ) region on the functional treatment of class II malocclusion: A randomized controlled trial

Oddziaływania ultradźwięków o niskiej intensywności stosowanych na okolicę stawu skroniowo-żuchwowego w leczeniu czynnościowym wad zgryzu klasy II – randomizowane badanie kontrolowane

Mohammad Osama Namera1,A,B,C,D,E,F, Ghiath Mahmoud1,A,D,E,F, Abdulaziz Abdulhadi1,A,B,C,D,E,F, Ahmad Burhan1,A,C,D,E,F

1 Department of Orthodontics, Faculty of Dentistry, University of Damascus, Syria


Background. Low-intensity pulsed ultrasound (LIPUS) is considered one of the techniques used to improve the mandibular growth. Many animal studies have reported that significant results can be obtained using LIPUS therapy with functional appliances.
Objectives. This research aimed to evaluate the dentoskeletal changes produced by the combination of LIPUS therapy and functional treatment during the correction of skeletal class II malocclusion.
Material and Methods. Forty-five patients aged 10.5–14 years with skeletal class II division 1 malocclusion were randomly divided into 3 equal groups: the LIPUS group, treated with a Twin-Block appliance in combination with LIPUS therapy; the TB group, treated with a Twin-Block appliance only; and the control group, which was observational and received no treatment. Cephalometric changes were compared between the 3 groups using the analysis of variance (ANOVA) and Tukey’s post hoc tests at p < 0.05.
Results. A greater significant decrease in the ANB (A point, nasion, B point) angle was observed in the treated groups (–2.67° for the LIPUS group and −2.11° for the TB group) as compared to the control group (p < 0.001). A greater improvement in the mandibular length and position was observed in the LIPUS group than in the TB group (p < 0.001). The changes in the control group as a result of continuing growth were minimal and clinically non-significant.
Conclusion. The application of LIPUS therapy in combination with functional treatment can have a great effect on growth stimulation during the correction of class II malocclusion. In addition, LIPUS was effective in reducing the duration of functional treatment.

Key words

Twin-Block appliance, low-intensity pulsed ultrasound (LIPUS), functional orthodontic treatment

Słowa kluczowe

aparat Twin-Block, ultradźwięki o niskiej intensywności (LIPUS), ortodontyczne leczenie czynnościowe

References (29)

  1. Bishara SE, ed. Textbook of Orthodontics. Philadelphia, PA: W.B. Saunders Company; 2001.
  2. Rosenblum RE. Class II malocclusion: Mandibular retrusion or maxil­lary protrusion? Angle Orthod. 1995;65(1):49–62.
  3. Basciftci FA, Uysal T, Büyükerkmen A, Sari Z. The effects of activator treatment on the craniofacial structures of Class II division 1 patients. Eur J Orthod. 2003;25 (1):87–93.
  4. Jena AK, Duggal R. Treatment effects of twin-block and mandibular protraction appliance-IV in the correction of class II malocclusion. Angle Orthod. 2010;80(3):485–491.
  5. Cozza P, Baccetti T, Franchi L, De Toffol L, McNamara JA Jr. Mandibular changes produced by functional appliances in Class II malocclusion: A systematic review. Am J Orthod Dentofacial Orthop. 2006;129(5):599.e1–e12.
  6. Proffit WR, White RP Jr. Who needs surgical-orthodontic treatment? Int J Adult Orthodon Orthognath Surg. 1990;5(2):81–89.
  7. Oksayan R, Ciftci ME, Aktan A, Sokucu O. Biostimulation of mandibu­lar condyle growth. J Orthod Res. 2015;3(3):147–150.
  8. Yang KH, Parvizi J, Wang SJ, et al. Exposure to low‐intensity ultrasound increases aggrecan gene expression in a rat femur fracture model. J Orthop Res. 1996;14(5):802–809.
  9. Mayr E, Frankel V, Rüter A. Ultrasound – an alternative healing method for nonunions? Arch Orthop Trauma Surg. 2000;120(1–2):1–8.
  10. El-Bialy T, El-Shamy I, Graber TM. Growth modification of the rabbit mandible using therapeutic ultrasound: Is it possible to enhance functional appliance results? Angle Orthod. 2003;73(6):631–639.
  11. El-Bialy T, Hassan A, Albaghdadi T, Fouad HA, Maimani AR. Growth modification of the mandible with ultrasound in baboons: A preli­minary report. Am J Orthod Dentofacial Orthop. 2006;130(4):435.e7–e14.
  12. El-Bialy T, Hasan A, Janadas A, Albaghdadi T. Nonsurgical treatment of hemifacial microsomia by therapeutic ultrasound and hybrid functional appliance. Open Access J Clin Trials. 2010;2:29–36.
  13. Maurya RK, Jayan B, Singh H, Nakra O, Sharma P. Effects of low‐intensity pulsed ultrasound therapy on the temporomandibular joint complex in conjunction with a fixed functional appliance: A prospective 3‐dimensional cone beam computed tomographic study. J Ultrasound Med. 2019;38(7):1661–1676.
  14. Baysal A, Uysal T. Dentoskeletal effects of Twin Block and Herbst appliances in patients with Class II division 1 mandibular retrognathy. Eur J Orthod. 2014;36(2):164–172.
  15. Fishman LS. Radiographic evaluation of skeletal maturation: A clini­cally oriented method based on hand-wrist films. Angle Orthod. 1982;52(2):88–112.
  16. Clark WJ. Twin Block Functional Therapy: Applications in Dentofacial Orthopaedics. 2nd ed. London, UK: Mosby: 2002.
  17. Tajali SB, Houghton P, MacDermid JC, Grewal R. Effects of low-intensity pulsed ultrasound therapy on fracture healing: A systematic review and meta-analysis. Am J Phys Med Rehabil. 2012;91(4):349–367.
  18. Shimazaki A, Inui K, Azuma Y, Nishimura N, Yamano Y. Low-intensity pulsed ultrasound accelerates bone maturation in distraction osteogenesis in rabbits. J Bone Joint Surg Br. 2000;82(7):1077–1082.
  19. Kristiansen TK, Ryaby JP, McCabe J, Frey JJ, Roe LR. Accelerated healing of distal radial fractures with the use of specific, low-intensity ultrasound: A multicenter, prospective, randomized, double-blind, placebo-controlled study. J Bone Joint Surg Am. 1997;79(7):961–973.
  20. O’Brien K, Wright J, Conboy F, et al. Effectiveness of early orthodontic treatment with the Twin-block appliance: A multicenter, randomized, controlled trial. Part 1: Dental and skeletal effects. Am J Orthod Dentofacial Orthop. 2003;124(3):234–243,quiz 339.
  21. Mills CM, McCulloch KJ. Treatment effects of the twin block appliance: A cephalometric study. Am J Orthod Dentofacial Orthop. 1998;114(1):15–24.
  22. Burhan AS, Nawaya FR. Dentoskeletal effects of the Bite-Jumping Appliance and the Twin-Block Appliance in the treatment of skeletal Class II malocclusion: A randomized controlled trial. Eur J Orthod. 2015;37(3):330–337.
  23. Tümer N, Gültan AS. Comparison of the effects of monoblock and twin-block appliances on the skeletal and dentoalveolar structures. Am J Orthod Dentofacial Orthop. 1999;116(4):460–468.
  24. Baccetti T, Franchi L, McNamara JA Jr, Tollaro I. Early dentofacial features of Class II malocclusion: A longitudinal study from the decidu­ous through the mixed dentition. Am J Orthod Dentofacial Orthop. 1997;111(5):502–509.
  25. Parkin NA, McKeown HF, Sandler PJ. Comparison of 2 modifications of the twin-block appliance in matched Class II samples. Am J Orthod Dentofacial Orthop. 2001;119(6):572–577.
  26. Schaefer AT, McNamara JA Jr, Franchi L, Baccetti T. A cephalometric comparison of treatment with the Twin-block and stainless steel crown Herbst appliances followed by fixed appliance therapy. Am J Orthod Dentofacial Orthop. 2004;126(1):7–15.
  27. Giuntini V, Vangelisti A, Masucci C, Defraia E, McNamara JA Jr, Franchi L. Treatment effects produced by the Twin-block appliance vs the Forsus Fatigue Resistant Device in growing Class II patients. Angle Orthod. 2015;85(5):784–789.
  28. Lund DI, Sandler PJ. The effects of Twin Blocks: A prospective controlled study. Am J Orthod Dentofacial Orthop. 1998;113(1):104–110.
  29. Baccetti T, Franchi L, Toth LR, McNamara JA Jr. Treatment timing for Twin-block therapy. Am J Orthod Dentofacial Orthop. 2000;118(2):159–170.