Effects of Sabbagh Universal Spring 2 appliance on cephalometric indices in patients with Class II division 1 versus division 2 malocclusions: A preliminary before–after clinical trial

Abstract

Background: Since there is no comparison between the effects of Sabbagh Universal Spring
2 (SUS2) appliance on Class II division 1 (div 1) versus Class II division 2 (div 2) patients, this
preliminary study was conducted to comparatively assess, for the first time, the effects of SUS2 on
34 cephalometric indices in Class II/1 versus Class II/2 patients.
Materials and Methods: This before–after clinical trial was conducted on 75 observations of
25 patients with Class II malocclusion, of whom 12 (9 females and 3 males) had Class II div 1 and
13 (11 females and 2 males) had Class II div 2 malocclusion diagnosed by clinical examination and
cephalometric assessment. The growth level of all patients had to be CS3 according to the cervical
vertebral maturation index. Lateral cephalographs were obtained before treatment (T0) and the
patients underwent fixed orthodontic treatment. Lateral cephalographs were taken again (T1) and
the patients received SUS2 functional appliance for 6 months. A final lateral cephalograph (T2)
was then obtained. Thirty‑four dentoskeletal indices were measured on lateral cephalographs, and
changes in indices over time were determined and compared using repeated‑measures analysis of
variance, post hoc test, and t‑test (α =0.05).
Results: Within‑group comparisons showed significant changes over time in SNB, sella nasion
(SN)/occlusal plane, ANB, articular (Ar)‑pogonion (Pog), L1‑NB, condylion (Co)‑gnathion , S‑Ar/Ar‑G,
B‑RL1, L1/nasion‑point B (NB), U6‑RL2, incisor mandibular plane angle, overjet, overbite, U1‑RL1,
and L1‑RL2 (P < 0.05). The two groups were significantly different in terms of changes occurred to
overjet, interincisal angle, U1/RL1, L1‑NB, U1‑NA, U1/NA, the Jarabak ratio, A‑RL1, U1/SN, Pog‑NB,
and Co‑A (P < 0.05).
Conclusion: The SUS2 showed therapeutic efficacy for both Class II div 1 and 2 patients although
it more commonly caused dentoalveolar rather than skeletal changes. Our study showed no
considerable difference between the two groups after using this appliance, and the difference in
the Jarabak ratio indicated better long‑term growth pattern of div 2 patients and its conformity
with camouflage treatments (mild or moderate Class II).
Key Words: Class II malocclusion, division 1, Class II malocclusion, division 2, malocclusion,
fixed functional appliance