Int J Stomatol ›› 2019, Vol. 46 ›› Issue (5): 578-584.doi: 10.7518/gjkq.2019082

• Reviews • Previous Articles     Next Articles

Effects of orthodontic treatment on changes in upper airway and peripheral structure in patients with skeletal Class Ⅱ malocclusion

Chen Yu,Jiang Huan,Liu Nan,Lu Chenmeng,Tang Zhongyuan,Han Ruyu,Hu Min()   

  1. Dept. of Orthodontics, Hospital of Stomatology, Jilin University, Changchun 130021, China
  • Received:2018-12-10 Revised:2019-05-02 Online:2019-09-01 Published:2019-09-10
  • Contact: Min Hu
  • Supported by:
    This study was supported by National Natural Science Foundation of China(81870195)


Skeletal Class Ⅱ malocclusion is a common malocclusion that affects not only the stomatognathic function and profile aesthetics but also the structure and function of the respiratory system. Patients with skeletal Class Ⅱ malocclusion are the high-risk groups of obstructive sleep apnea-hypopnea syndrome. As the important physiological structure of the human craniomaxillofacial region, the shape, size and patency of the upper airway affect normal breathing and sleep directly. Malocclusion correction can affect the dental and maxillofacial structure to a certain extent. The upper airway is a part of the dental and maxillofacial structure that may also change. This article reviews the physiological characteristics of the upper airway in patients with skeletal Class Ⅱ malocclusion and the effect of different orthodontic treatments on the upper airway in patients with skeletal Class Ⅱ malocclusion.

Key words: skeletal Class Ⅱ malocclusion;, upper airway, orthodontic treatment

CLC Number: 

  • R 783.5

[1] Raffaini M, Pisani C . Clinical and cone-beam com­puted tomography evaluation of the three-dimensional increase in pharyngeal airway space following maxillo-mandibular rotation-advancement for Class Ⅱ-correction in patients without sleep apnoea (OSA)[J]. J Craniomaxillofac Surg, 2013,41(7):552-557.
[2] Nanda M, Singla A, Negi A , et al. The association between maxillomandibular sagittal relationship and pharyngeal airway passage dimensions[J]. J Ind Or­thod Soc, 2012,46(1):48-52.
[3] Alves PV, Zhao LP , O’Gara M, et al. Three-dimensional cephalometric study of upper airway space in ske­letal class Ⅱ and Ⅲ healthy patients[J]. J Craniofac Surg, 2008,19(6):1497-1507.
[4] Zhong Z, Tang ZH, Gao XM , et al. A comparison study of upper airway among different skeletal craniofacial patterns in nonsnoring Chinese children[J]. Angle Orthod, 2010,80(2):267-274.
[5] 曾祥龙, 唐志慧 . 矢状骨面型与上气道形态和舌骨位置关系的研究[J]. 现代口腔医学杂志, 2004,18(3):231-234.
Zeng XL, Tang ZH . A study of relationship between upper airway form and hyoid position and sagittal facial type[J]. J Modern Stomatol, 2004,18(3):231-234.
[6] 陈科名, 杨崇实, 邓锋 . 不同矢状骨面型错畸形患者气道大小形态的CBCT研究[J]. 口腔医学研究, 2012,28(1):54-57.
Chen KM, Yang CS, Deng F . Airway morphology and volume in malocclusion patients with different sagittal facial types[J]. J Oral Sci Res, 2012,28(1):54-57.
[7] 方志欣, 周嫣, 黄敏方 , 等. 矢状Ⅱ类不同垂直骨面型成人上气道形态的测量分析[J]. 实用口腔医学杂志, 2009,25(3):416-419.
Fang ZX, Zhou Y, Huang MF , et al. Upper airway forms of the adults with classⅡsagittal facial type[J]. J Pract Stomatol, 2009,25(3):416-419.
[8] 王天虎, 李永明, 杨芳 , 等. 成人骨性Ⅱ类上气道与颅颌面关系初探[J]. 现代生物医学进展, 2013,13(15):2901-2907, 2851.
Wang TH, Li YM, Yang F , et al. A three-dimensional study of upper airway in adult skeletal Class Ⅱpa­tients with different vertical patterns[J]. Prog Mod Biomed, 2013,13(15):2901-2907, 2851.
[9] 廉晨晨 . 成人骨性Ⅱ类不同垂直骨面型气道容积与舌骨位置的CBCT分析[D]. 大连: 大连医科大学, 2017.
Lian CC . The analysis based on CBCT for airway volume and hyoid bone position abnormal changes related with diverse ClassⅡskeletal vertical facial type[D]. Dalian: Dalian Medical University, 2017.
[10] Di Carlo G, Polimeni A, Melsen B , et al. The re­lationship between upper airways and craniofacial morphology studied in 3D. A CBCT study[J]. Orthod Craniofac Res, 2015,18(1):1-11.
[11] Lee RW, Sutherland K, Chan AS , et al. Relationship between surface facial dimensions and upper airway structures in obstructive sleep apnea[J]. Sleep, 2010,33(9):1249-1254.
[12] Ghodke S, Utreja AK, Singh SP , et al. Effects of twin-block appliance on the anatomy of pharyngeal airway passage (PAP) in Class Ⅱ malocclusion subjects[J]. Prog Orthod, 2014,15:68.
[13] Jena AK, Singh SP, Utreja AK . Effectiveness of twin-block and Mandibular Protraction Appliance-Ⅳ in the improvement of pharyngeal airway passage dimensions in Class Ⅱ malocclusion subjects with a retrognathic mandible[J]. Angle Orthod, 2013,83(4):728-734.
[14] Vinoth SK, Thomas AV, Nethravathy R . Cephalomteric changes in airway dimensions with twin block therapy in growing Class Ⅱ patients[J]. J Pharm Bioallied Sci, 2013,5(Suppl 1):S25-S29.
[15] 史建陆, 董丽玲, 李芸 , 等. 安氏Ⅱ类下颌后缩儿童应用Twin-block矫治器功能矫治前后上气道变化的锥形束CT研究[J]. 实用口腔医学杂志, 2015,31(4):531-535.
Shi JL, Dong LL, Li Y , et al. A CBCT study on the upper airway of the children with Class Ⅱ mandi­bular retrusion before and after functional treatment by Twin-block appliance[J]. J Pract Stomatol, 2015,31(4):531-535.
[16] Elfeky HY, Fayed MMS . Three-dimensional effects of twin block therapy on pharyngeal airway parame­ters in Class Ⅱ malocclusion patients[J]. J World Fed Orthod, 2015,4(3):114-119.
[17] Li L, Liu H, Cheng HJ , 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[J]. PLoS One, 2014,9(4):e94378.
[18] Han S, Choi YJ, Chung CJ , et al. Long-term pharyngeal airway changes after bionator treatment in adolescents with skeletal Class Ⅱ malocclusions[J]. Korean J Orthod, 2014,44(1):13-19.
[19] Lotfi V, Ghoneima A, Lagravere M , et al. Three-dimensional evaluation of airway volume changes in two expansion activation protocols[J]. Int Orthod, 2018,16(1):144-157.
[20] Izuka EN, Feres MF, Pignatari SS. Immediate impact of rapid maxillary expansion on upper airway di­mensions and on the quality of life of mouth brea­thers [J]. Dental Press J Orthod, 2015,20(3):43-49.
[21] Almuzian M, Ju XY, Almukhtar A , et al. Does rapid maxillary expansion affect nasopharyngeal airway? A prospective cone beam computerised tomography (CBCT) based study[J]. Surgeon, 2018,16(1):1-11.
[22] 熊晖 . 采用Dolphin软件研究上颌快速扩弓对颌面三维组织结构的影响[ C]//第二十届中国国际口腔学术研讨会汇编. 2016: 97.
Xiong H . Three dimensional evaluation by Dolphin Image: immediate effects on maxillofacial structures after RME[ C]//Proceedings of the 20th China In­ternational Symposium on Dental Equipment, Technology & Products. 2016: 97.
[23] El H, Palomo JM . Three-dimensional evaluation of upper airway following rapid maxillary expansion: a CBCT study[J]. Angle Orthod, 2014,84(2):265-273.
[24] Iwasaki T, Saitoh I, Takemoto Y , et al. Tongue posture improvement and pharyngeal airway enlargement as secondary effects of rapid maxillary expansion: a cone-beam computed tomography study[J]. Am J Orthod Dentofacial Orthop, 2013,143(2):235-245.
[25] Ribeiro AN, de Paiva JB, Rino-Neto J , et al. Upper airway expansion after rapid maxillary expansion evaluated with cone beam computed tomography[J]. Angle Orthod, 2012,82(3):458-463.
[26] Nada RM, van Loon B, Schols JG , et al. Volumetric changes of the nose and nasal airway 2 years after tooth-borne and bone-borne surgically assisted rapid maxillary expansion[J]. Eur J Oral Sci, 2013,121(5):450-456.
[27] Kim SY, Park YC, Lee KJ , et al. Assessment of changes in the nasal airway after nonsurgical mi­niscrew-assisted rapid maxillary expansion in young adults[J]. Angle Orthod, 2018,88(4):435-441.
[28] Smith T, Ghoneima A, Stewart K , et al. Three-dimen­sional computed tomography analysis of airway volume changes after rapid maxillary expansion[J]. Am J Orthod Dentofacial Orthop, 2012,141(5):618-626.
[29] Sadeghian S, Ghafari R, Feizbakhsh M , et al. Dime­nsional changes of upper airway after rapid maxillary expansion evaluated with cone beam computed tomography[J]. Orthod Waves, 2016,75(1):10-17.
[30] 曹闪闪 . 高角Ⅱ类青少年扩弓前后舌骨位置的变化[ C]//2017年国际正畸大会暨第十六次全国口腔正畸学术会议论文汇编. 2017: 142.
Cao SS . Changes of hyoid position before and after arch expansion in hyperdivergent Class Ⅱ adole­scents[ C]//Proceedings of the 2017 International Or- thodontic Conference and the 16th National Ortho-dontic Conference. 2017: 142.
[31] 肖依寒 . 上下联合扩弓对不同矢状骨面型上气道影响的三维测量分析[D]. 大连: 大连医科大学, 2017.
Xiao YH . Three-dimensional measurement and analysis of the effects of maxillomandibular ex­pansion on upper airway in different sagittal skeletal pattern[D]. Dalian: Dalian Medical University, 2017.
[32] Holty JE, Guilleminault C . Maxillomandibular ex­pansion and advancement for the treatment of sleep-disordered breathing in children and adults[J]. Semin Orthod, 2012,18(2):162-170.
[33] Guimarães CH Jr, Henriques JF, Janson G , et al. Prospective study of dentoskeletal changes in Class Ⅱ division malocclusion treatment with twin force bite corrector[J]. Angle Orthod, 2013,83(2):319-326.
[34] Hu ZA, Yin X, Liao J , et al. The effect of teeth ex­traction for orthodontic treatment on the upper airway: a systematic review[J]. Sleep Breath, 2015,19(2):441-451.
[35] Zhang JJ, Chen G, Li WR , et al. Upper airway changes after orthodontic extraction treatment in adults: a preliminary study using cone beam computed tomo­graphy[J]. PLoS One, 2015,10(11):e0143233.
[36] 何文丹, 林巍, 周志迎 . 三维重建后的锥形束CT在安氏Ⅱ类1分类高角型Damon技术拔牙矫治后气道改善的研究[J]. 现代诊断与治疗, 2016,27(4):619-621.
He WD, Lin W, Zhou ZY . Study of cone beam CT three-dimensional reconstruction after the airway in class Ⅱ division 1 high Angle damon after extraction treatment improved[J]. Modern Diag Treat, 2016,27(4):619-621.
[37] Ristow O, Rückschloß T, Berger M , et al. Short- and Long-term changes of the pharyngeal airway after surgical mandibular advancement in Class Ⅱ patients: a three-dimensional retrospective study[J]. J Cranio­maxillofac Surg, 2018,46(1):56-62.
[38] Kochel J, Meyer-Marcotty P, Sickel F , et al. Short-term pharyngeal airway changes after mandibular advancement surgery in adult Class Ⅱ-patients: a three-dimensional retrospective study[J]. J Orofac Orthop, 2013,74(2):137-152.
[39] de Sousa Miranda W , Álvares de Castro Rocha V, Lara Dos Santos Marques K, et al. Three-dimensional evaluation of superior airway space after orthognathic surgery with counterclockwise rotation and advance­ment of the maxillomandibular complex in Class Ⅱpatients[J]. Oral Surg Oral Med Oral Pathol Oral Radiol, 2015,120(4):453-458.
[40] Kochar GD, Chakranarayan A, Kohli S , et al. Effect of surgical mandibular advancement on pharyngeal airway dimensions: a three-dimensional computed tomography study[J]. Int J Oral Maxillofac Surg, 2016,45(5):553-559.
[41] Kim T, Baek SH, Choi JY . Effect of posterior impac­tion and setback of the maxilla on retropalatal airway and velopharyngeal dimensions after two-jaw surgery in skeletal Class Ⅲ patients[J]. Angle Orthod, 2015,85(4):625-630.
[42] Jiang CM, Yi YT, Jiang CX , et al. Pharyngeal airway space and hyoid bone positioning after different or­tho­gnathic surgeries in skeletal Class Ⅱ patients[J]. J Oral Maxillofac Surg, 2017,75(7):1482-1490.
[43] Hourfar J, Kinzinger GSM, Feifel H , et al. Effects of combined orthodontic-orthognathic treatment for Class Ⅱ and Ⅲ correction on posterior airway space: Comparison of mono- and bignathic osteotomies[J]. J Orofac Orthop, 2017,78(6):455-465.
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