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  1. Fareen N, Alam MK, Khamis MF, Mokhtar N
    Orthod Craniofac Res, 2017 Aug;20(3):134-139.
    PMID: 28440029 DOI: 10.1111/ocr.12179
    OBJECTIVE: Reverse Twin-Block (RTB) and Reverse Pull Face Mask (RPFM) appliances are used to correct Class III malocclusion in growing patients. Aim of this retrospective study was to compare and analyse craniofacial changes produced by RTB and RPFM in the early and late mixed dentition in Malay children with Class III malocclusion.

    METHODS: Data consisted of pre- and post-treatment lateral cephalograms of 95 children, 49 patients with RTB and 46 patients with RPFM, divided into an early (8-9 year) and late (10-11 year) group. Treatment changes were assessed by the Ricketts analysis using CASSOS software, where 71 anatomic landmarks were identified in each cephalogram. Paired and independent t tests were performed for statistical comparison.

    RESULTS: Paired t test revealed significant changes in facial axis, facial angle, MD plane to FH, lower facial height, mandibular arc, maxillary convexity, U1 to APog, L1 to APog, L1 to APog angle and upper lip to E-plane measurements in RPFM, whereas significant changes were found in facial taper, U1 to APog and lower lip to E-plane values with RTB in the early treatment group. Independent t test revealed significant changes in U1 to APog, L1 to APog and U6 to PtV values in the RTB group. Post-treatment comparison of RTB and RPFM showed significant differences in L1 to APog and L1 to APog angle values.

    CONCLUSIONS: RPFM revealed more favourable craniofacial changes than RTB, particularly in the late mixed dentition stage.

  2. Fareen N, Alam MK, Khamis MF, Mokhtar N
    Int J Pediatr Otorhinolaryngol, 2019 Oct;125:159-163.
    PMID: 31323354 DOI: 10.1016/j.ijporl.2019.07.008
    BACKGROUND: Treatment of Class III malocclusion is related to redirecting the growth of mandible, which may have an impact on the pharyngeal airway.

    OBJECTIVE: To evaluate and compare the treatment effect of Reverse Twin-Block (RTB) and Reverse Pull Face Mask (RPFM) on Pharyngeal Airway Space (PAS) in early and late mixed dentition Class III samples.

    METHODS: Ninety-five mixed dentition Malay children with Class III malocclusion were included in this study. Data consists of 190 pre- and post-treatment lateral cephalograms of early (8-9 years) and late (10-11 years) mixed dentition Class III samples. forty-nine samples were under RTB and forty-six samples were under RPFM. Treatment changes were evaluated by McNamara airway analysis and changes in tongue and hyoid bone position.

    RESULTS: Both upper and lower pharyngeal airway width were increased after treatment with RTB and RPFM ruling out the chance of airway constriction. There was also posterior positioning of the tongue and hyoid bone indicating mandibular retrusion. No significant treatment changes were found on the Pharyngeal Airway Space by the factor age, gender or type of appliance.

    CONCLUSIONS: Both RTB and RPFM increased the Pharyngeal Airway Space and produced similar treatment effect. As age does not affect the treatment outcome significantly, treatment can be delayed until late mixed dentition stage.

  3. Fareen N, Alam MK, Khamis MF, Mokhtar N
    Biomed Res Int, 2021;2021:6612598.
    PMID: 33834067 DOI: 10.1155/2021/6612598
    Objective: This study was focused on comparing and analyzing the soft tissue changes induced by Reverse Twin-Block (RTB) and Reverse Pull Face Mask (RPFM) in early and late mixed dentition Malay children having Class III malocclusion.

    Methods: This cross-sectional study includes a total sample of 95 Malay children of both early (8-9 years) and late (10-11 years) mixed dentition stages. The comparison was between 49 samples treated by RTB and 46 samples treated by RPFM. Both pre- and posttreatment changes were assessed with Holdaway's analysis using the CASSOS software. In each cephalogram, 71 anatomic landmarks were traced. Descriptive and multiple regression analyses were performed for statistical evaluation.

    Results: Statistically significant changes were noticed in soft tissue facial angle, subnasale to H-line, skeletal profile convexity, upper lip strain, H-line angle, lower lip to H-line, and inferior sulcus to H-line measurements. Gender disparity was noticed in upper lip strain. Other significant changes were influenced by the type of appliance. However, the mean differences were minute to notice clinically. Age difference did not have any effect on the treatment changes.

    Conclusions: RPFM revealed treatment outcome with more protruded upper lip than RTB.

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