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Improved clinical use of Twin-block and Herbst as a result of radiating viscoelastic tissue forces on the condyle and fossa in treatment and long-term retention: growth relativity.
Am J Orthod Dentofacial Orthop 2000; 117(3):247-66AJ

Abstract

Understanding mechanisms of action for orthopedic appliances is critical for orthodontists who hope to treat and retain the achieved corrections in patients with initial Class II mandibular retrognathism. That knowledge can help orthodontists produce clinically significant bone formation and avoid compression at the condyle-glenoid fossa region. It also assists us to understand the differences between short-term and long-term treatment results. It was previously thought that increased activity in the postural masticatory muscles was the key to promoting condyle-glenoid fossa growth. By analyzing results from several studies, we postulate that growth modification is associated with decreased activity, which leads to our nonmuscular hypothesis. This premise has its foundation on 3 key specific findings: significant glenoid fossa bone formation occurs during treatment that includes mandibular displacement; glenoid fossa modification is a result of the stretch forces of the retrodiskal tissues, capsule, and altered flow of viscous synovium; observations that glenoid fossa bone formation takes place a distance from the soft tissue attachment. The latter observation is explained by transduction or referral of forces. Evidence is presented, therefore, that the 3 trigger switches for glenoid fossa growth can similarly initiate short-term condylar growth modifications because the 2 structures are contiguous. These are displacement, several direct viscoelastic connections, and transduction of forces. Histologic evidence further shows that stretched retrodiskal tissues also insert directly into the condylar head's fibrocartilaginous layer. The impact of the viscoelastic tissues may be highly significant and should be considered along with the standard skeletal, dental, neuromuscular, and age factors that influence condyle-glenoid fossa growth with orthopedic advancement. These biodynamic factors are also capable of reversing effects of treatment on mandibular growth direction, size, and morphology. Relapse occurs as a result of release of the condyle and ensuing compression against the newly proliferated retrodiskal tissues together with the reactivation of muscle activity. To describe condyle-glenoid fossa growth modification, an analogy is made to a light bulb on a dimmer switch. The condyle illuminates in treatment, dims down in the retention period, to near base levels over the long-term.

Authors+Show Affiliations

Division of Growth and Developmental Sciences Department of Orthodontics, New York University, NY, USA.No affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

10715086

Citation

Voudouris, J C., and M M. Kuftinec. "Improved Clinical Use of Twin-block and Herbst as a Result of Radiating Viscoelastic Tissue Forces On the Condyle and Fossa in Treatment and Long-term Retention: Growth Relativity." American Journal of Orthodontics and Dentofacial Orthopedics : Official Publication of the American Association of Orthodontists, Its Constituent Societies, and the American Board of Orthodontics, vol. 117, no. 3, 2000, pp. 247-66.
Voudouris JC, Kuftinec MM. Improved clinical use of Twin-block and Herbst as a result of radiating viscoelastic tissue forces on the condyle and fossa in treatment and long-term retention: growth relativity. Am J Orthod Dentofacial Orthop. 2000;117(3):247-66.
Voudouris, J. C., & Kuftinec, M. M. (2000). Improved clinical use of Twin-block and Herbst as a result of radiating viscoelastic tissue forces on the condyle and fossa in treatment and long-term retention: growth relativity. American Journal of Orthodontics and Dentofacial Orthopedics : Official Publication of the American Association of Orthodontists, Its Constituent Societies, and the American Board of Orthodontics, 117(3), pp. 247-66.
Voudouris JC, Kuftinec MM. Improved Clinical Use of Twin-block and Herbst as a Result of Radiating Viscoelastic Tissue Forces On the Condyle and Fossa in Treatment and Long-term Retention: Growth Relativity. Am J Orthod Dentofacial Orthop. 2000;117(3):247-66. PubMed PMID: 10715086.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Improved clinical use of Twin-block and Herbst as a result of radiating viscoelastic tissue forces on the condyle and fossa in treatment and long-term retention: growth relativity. AU - Voudouris,J C, AU - Kuftinec,M M, PY - 2000/3/14/pubmed PY - 2000/4/15/medline PY - 2000/3/14/entrez SP - 247 EP - 66 JF - American journal of orthodontics and dentofacial orthopedics : official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics JO - Am J Orthod Dentofacial Orthop VL - 117 IS - 3 N2 - Understanding mechanisms of action for orthopedic appliances is critical for orthodontists who hope to treat and retain the achieved corrections in patients with initial Class II mandibular retrognathism. That knowledge can help orthodontists produce clinically significant bone formation and avoid compression at the condyle-glenoid fossa region. It also assists us to understand the differences between short-term and long-term treatment results. It was previously thought that increased activity in the postural masticatory muscles was the key to promoting condyle-glenoid fossa growth. By analyzing results from several studies, we postulate that growth modification is associated with decreased activity, which leads to our nonmuscular hypothesis. This premise has its foundation on 3 key specific findings: significant glenoid fossa bone formation occurs during treatment that includes mandibular displacement; glenoid fossa modification is a result of the stretch forces of the retrodiskal tissues, capsule, and altered flow of viscous synovium; observations that glenoid fossa bone formation takes place a distance from the soft tissue attachment. The latter observation is explained by transduction or referral of forces. Evidence is presented, therefore, that the 3 trigger switches for glenoid fossa growth can similarly initiate short-term condylar growth modifications because the 2 structures are contiguous. These are displacement, several direct viscoelastic connections, and transduction of forces. Histologic evidence further shows that stretched retrodiskal tissues also insert directly into the condylar head's fibrocartilaginous layer. The impact of the viscoelastic tissues may be highly significant and should be considered along with the standard skeletal, dental, neuromuscular, and age factors that influence condyle-glenoid fossa growth with orthopedic advancement. These biodynamic factors are also capable of reversing effects of treatment on mandibular growth direction, size, and morphology. Relapse occurs as a result of release of the condyle and ensuing compression against the newly proliferated retrodiskal tissues together with the reactivation of muscle activity. To describe condyle-glenoid fossa growth modification, an analogy is made to a light bulb on a dimmer switch. The condyle illuminates in treatment, dims down in the retention period, to near base levels over the long-term. SN - 0889-5406 UR - https://www.unboundmedicine.com/medline/citation/10715086/Improved_clinical_use_of_Twin_block_and_Herbst_as_a_result_of_radiating_viscoelastic_tissue_forces_on_the_condyle_and_fossa_in_treatment_and_long_term_retention:_growth_relativity_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0889540600368913 DB - PRIME DP - Unbound Medicine ER -