- Visibility 249 Views
- Downloads 271 Downloads
- Permissions
- DOI 10.18231/j.jco.v.9.i.3.17
-
CrossMark
The role of patient motivation in long-term success of Class II malocclusion treatment: A five-year follow-up case report
- Author Details:
-
Esraa Salem Sahab
-
Shoroog Hassan Agou *
Esraa Salem Sahab
Shoroog Hassan Agou *
Background: Class II malocclusion is the most frequent maxillo–mandibular skeletal discrepancy in preadolescents, typically linked to mandibular retrognathia. Growth‑modification appliances are widely used, yet outcomes vary because success hinges on timing, comfort, and sustained compliance. Self‑Determination Theory (SDT) highlights that satisfying autonomy, competence, and relatedness needs promotes internal (self‑endorsed) motivation, crucial for adherence to removable functional appliances. The Medium Opening Activator (MOA) is a contemporary functional design intended to improve tolerability while simultaneously addressing sagittal discrepancy, deep bite, and lower‑incisor control.
Case: We describe the two‑stage management of a ten‑year‑old girl treated first with an MOA during the growth‑modification phase, followed by comprehensive fixed therapy. High appliance wear was maintained through autonomy‑supportive communication, neutral progress benchmarks, individualized micro‑goals, and adaptive twin sibling comparison that provided informational feedback and mutual encouragement. These processes likely supported need satisfaction and internalization, contributing to favourable Class II correction, deep‑bite improvement, and long‑term stability.
Conclusion: By operationalizing self‑determination principles (autonomy‑supportive dialogue, informational benchmarks, individualized micro‑goals, prosocial encouragement), this case achieved sustained MOA wear, successful Class II correction, and stability at five‑year post‑treatment follow‑up. Need satisfaction (autonomy, competence, relatedness) remains a crucial determinant of removable appliance outcomes; when present, the MOA functions as an effective first‑phase intervention in appropriate growing Class II patients.
References
- Kelly JE, Harvey CR. An assessment of the occlusion of the teeth of youths 12-17 years. Vital Health Stat 11. 1977;162:1-65.
- McLain JB, Proffitt WR. Oral health status in the United States: prevalence of malocclusion. J Dent Educ. 1985;49(6):386-97.
- Proffit WR, Fields HW, Jr., Moray LJ. Prevalence of malocclusion and orthodontic treatment need in the United States: estimates from the NHANES III survey. Int J Adult Orthodon Orthognath Surg. 1998;13(2):97-106.
- Mohammed Almalky N, Mohammad Elattar H. Prevalence of different types of malocclusion among school children in Makkah Governorate of Saudi Arabia. Int J Dent Oral Sci. 2018;5:645-8.
- Alhummayani FM, Taibah SM. Orthodontic treatment needs in Saudi young adults and manpower requirements. Saudi Med J. 2018;39(8):822-8.
- McNamara JA, Jr. Components of class II malocclusion in children 8-10 years of age. Angle Orthod. 1981;51(3):177-20.
- Dosdogru EY, Görken FN, Erdem AP, Öztas E, Marsan G, Sepet E, et al. Maxillary incisor trauma in patients with class II division 1 dental malocclusion: associated factors. J Istan Uni Facul Dent. 2017;51(1):34-41.
- Batista KB, Thiruvenkatachari B, Harrison JE, O'Brien KD. Orthodontic treatment for prominent upper front teeth (Class II malocclusion) in children and adolescents. Cochrane Database Syst Rev. 2018;3(3):CD003452.
- Dimberg L, Arnrup K, Bondemark L. The impact of malocclusion on the quality of life among children and adolescents: a systematic review of quantitative studies. Eur J Orthodon. 2015;37(3):238-47.
- Javidi H, Vettore M, Benson PE. Does orthodontic treatment before the age of 18 years improve oral health-related quality of life? A systematic review and meta-analysis. Am J Orthodon Dentofacial Orthoped. 2017;151(4):644-55.
- Stahl F, Baccetti T, Franchi L, McNamara Jr JA. Longitudinal growth changes in untreated subjects with Class II Division 1 malocclusion. Am J Orthodon Dentofacial Orthoped. 2008;134(1):125-37.
- Andresen V, Häupl K. Funktions-Kieferorthopädie: die grundlagen des" norwegischen systems". Barth, Leipzig, 1936.
- 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 e1-12; discussion e1-6.
- McNamara JA, Brudon WL, Kokich VG. Orthodontics and dentofacial orthopedics: Needham Press, Ann Arbor; 2001.
- O'Brien K, Wright J, Conboy F, Appelbe P, Davies L, Connolly I, et al. Early treatment for Class II Division 1 malocclusion with the Twin-block appliance: a multi-center, randomized, controlled trial. Am J Orthod Dentofacial Orthop. 2009;135(5):573-9.
- Koretsi V, Zymperdikas VF, Papageorgiou SN, Papadopoulos MA. Treatment effects of removable functional appliances in patients with Class II malocclusion: a systematic review and meta-analysis. Eur J Orthod. 2015;37(4):418-34.
- Marsico E, Gatto E, Burrascano M, Matarese G, Cordasco G. Effectiveness of orthodontic treatment with functional appliances on mandibular growth in the short term. Am J Orthod Dentofacial Orthop. 2011;139(1):24-36.
- Santamaria-Villegas A, Manrique-Hernandez R, Alvarez-Varela E, Restrepo-Serna C. Effect of removable functional appliances on mandibular length in patients with class II with retrognathism: systematic review and meta-analysis. BMC Oral Health. 2017;17(1):52.
- Casutt C, Pancherz H, Gawora M, Ruf S. Success rate and efficiency of activator treatment. Eur J Orthod. 2007;29(6):614-21.
- Idris G, Hajeer MY, Al-Jundi A. Soft- and hard-tissue changes following treatment of Class II division 1 malocclusion with Activator versus Trainer: a randomized controlled trial. Eur J Orthod. 2019;41(1):21-8.
- Pancherz H. The mandibular plane angle in activator treatment. Angle Orthod. 1979;49(1):11-20.
- Maspero C, Galbiati G, Giannini L, Guenza G, Farronato M. Class II division 1 malocclusions: comparisons between one-and two-step treatment. Eur J Paediatr Dent. 2018;19(4):295-9.
- Thiruvenkatachari B, Harrison J, Worthington H, O'Brien K. Early orthodontic treatment for Class II malocclusion reduces the chance of incisal trauma: Results of a Cochrane systematic review. Am J Orthod Dentofacial Orthop. 2015;148(1):47-59.
- Baccetti T, Franchi L, Toth LR, McNamara JA, Jr. Treatment timing for Twin-block therapy. Am J Orthod Dentofacial Orthop. 2000;118(2):159-70.
- Littlewood SJ, Mitchell L. An introduction to orthodontics: Oxford university press; 2019.
- Turley PK. Orthodontic Management of the Short Face Patient. Dent Clin North Am. 1997;41(1):129-50.
- Pacha MM, Fleming PS, Johal A. A comparison of the efficacy of fixed versus removable functional appliances in children with Class II malocclusion: A systematic review. Eur J Orthod. 2016;38(6):621-30.
- Bishara SE, Hoppens BJ, Jakobsen JR, Kohout FJ. Changes in the molar relationship between the deciduous and permanent dentitions: 404 Sahab and Agou / Journal of Contemporary Orthodontics 2025;9(3):398–404 a longitudinal study. Am J Orthod Dentofacial Orthop. 1988;93(1):19-28.
- Hsieh TJ, Pinskaya Y, Roberts WE. Assessment of orthodontic treatment outcomes: early treatment versus late treatment. Angle Orthod. 2005;75(2):162-70
- King GJ, McGorray SP, Wheeler TT, Dolce C, Taylor M. Comparison of peer assessment ratings (PAR) from 1-phase and 2- phase treatment protocols for Class II malocclusions. Am J Orthod Dentofacial Orthop. 2003;123(5):489-96.
- Kluemper GT, Beeman CS, Hicks EP. Early orthodontic treatment: what are the imperatives? J Am Dent Assoc. 2000;131(5):613-20.
- Huang G. The Twin-block appliance, used during the mixed dentition in Class II Division I malocclusions, may provide psychosocial benefits. J Evid Based Den Pract. 2004;4(4):286-7.
- Keski-Nisula K, Lehto R, Lusa V, Keski-Nisula L, Varrela J. Occurrence of malocclusion and need of orthodontic treatment in early mixed dentition. Am J Orthod Dentofacial Orthop. 2003;124(6):631-8.
- King GJ, Wheeler TT, McGorray SP, Aiosa LS, Bloom RM, Taylor MG. Orthodontists' perceptions of the impact of phase 1 treatment for Class II malocclusion on phase 2 needs. J Dent Res. 1999;78(11):1745-53.
- O'Brien K, Wright J, Conboy F, Sanjie Y, Mandall N, Chadwick S, 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):234-43.
- Lager H, editor. The individual growth pattern and stage of maturation as a basis for treatment of distal occlusion with overjet. Report of the congress European Orthodontic Society; 1967.
- Torsello F, D’Amico G, Staderini E, Marigo L, Cordaro M, Castagnola R. Factors Influencing Appliance Wearing Time during Orthodontic Treatments: A Literature Review. Appl Sci. 2022;12(15):7807.
- Stefanovic NL, Uhac M, Brumini M, Zigante M, Perkovic V, Spalj S. Predictors of patient compliance during Class II division 1 malocclusion functional orthodontic treatment. Angle Orthod. 2021;91(4):502-8.
- Halvari A, Halvari H. Motivational predictors of change in oral health: An experimental test of self-determination theory. Motiv Emot. 2006;30(4):295-306.
- Ryan RM, Patrick H, Deci EL, Williams GC. Self-determination theory: its application to health behavior and complementarity with motivational interviewing. Int J Behav Nutr Phys Act. 2012;9:18.