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William A. Angle Orthod 1 January ; 29 1 : 45— Albuquerque, N. The primary purpose of this studywas to determine the facial skeletalchanges which occur during treatmentwith the full edgewise appliance pluscervical traction. The cases recordedwere classified as Class 11, Division 1and Class I with Class I1 tendencies,all without extractions.

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The neckbandappliance was the prime motivatingfactor for redyction of the Class I1relationship or tendency. Much of the credit for the wide-spread revival of extraoral anchorageis due Kloehn. His work, as first report-ed at the meeting of the Mid-westernComponent of the Edward AngleSociety of Orthodontia,mademembers of the profession aware of thevalue of cervical traction in a privatepractice.

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Kloehn stressed the guidanceof growth and the conservation ofmandibular anchorage made possiblewith the cervical gear. The cases dis-cussed in this paper were treated withthese fundamental aspects in mind.

Thirty-four individuals are repre-sented : seventeen boys and seventeengirls. Six of the boys and six of the girlshad two periods of treatment, a pre-liminary period with the neckband ap-pliance only, and a second period witha full edgewise appliance added.

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Themean starting age for the preliminaryperiod was ten years while the meantreatment time was eleven months. For the eleven boys and eleven girlswho were treated in one period, themean starting age was thirteen years,and the mean treatment time eighteenmonths.

Tracings of before and after treat-ment lateral head x-rays were made. All angular values were read with astandard protractor and lineal measure-ments were determined with millimeterrule. The Frankfort plane of eachoriginal tracing was transferred to thesecond by superimposition of the SNplane registered at S. The linear measurements were: SAand SB. The pointS was selected as a base from whichto measure because it has been estab-lished as one of the most stable pointsof reference in the head.

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Class I cases demonstrating a ClassI1 tendency were included with theClass 11, Division 1 cases in this studybecause therapy was identical. Further-more, Landes showed the same generaltendencies in growth behavior regard-less of type.

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Silversteinlo concludedthat in his sample there was no sig-nificant difference in growth trends be 46 Blueher January, tween untreated Class I1 cases and un-treated normals. Lande8 evinced relative stability ofthe anterior maxillary area in untreatedcases.

He went further to confirmBrodie's observation that the alveolargrowth did not keep pace with thegrowth of its skeletal base in a hori-zontal. Both substantiated thefindings in this regard of earlierworkers. Carlson' in an unpublished thesisctudying ten boys and ten girls withcxcellent occlusions showed a slight in-crease in SNA from ages eight to seven-teen, the increase being greater in malesthan females. Silverstein'" found that SNA tendedto decrease in males with treatmentbut not in females.

Graber4 spoke oftreatment cases in which maxillary al-veolar growth was apparently held backby extraoral appliances. Stoner", and co-workers using alinear measurement demonstrated a re-duction of point A in cases treated byTweed. King' showed a similar reduc-tion with cervical traction. Klein6 aftermeasuring SNA writes of an averageretraction of 1.

Eight,of his twenty-four cases yielded no change.

In the gir:s the largest decreare was 7',the least. Itmust be noted that the average re-duction in the girls without the unusualhigh of 7" would have been 1. There was a reduction infifteen of the seventeen boys and four-teen of the seventeen girls.

Only one individual, a boy, in thethirty-four total cases showed an in-crease in SNA 2. The before andafter readings remained the same forone boy and three girls.

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In summationthere was an SNA reduction in twenty-nine of thirty-four cases; the angle re-mained the same in four cases, and in-crrasPd in one. Lnrnr Measurements of Point AThe SA distance along Frankfortplane decreased in eight of the seven-teen boys, twelve of the seventeen girls.

Thc greatest decrease in the boys was3 nim. The largest decrease in girls was4 mm. The distance from S to A increasedin nine boys and in only three girls. The high increase in the boys was 4.

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The high in the girls was 4 mm. Two of the girls remained thesame.

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In this instance,we have shown that the forward growthof the maxillary anterior alveolarprocess was restricted in full edgewiseappliance cases using the neckband ap-pliance as the restraining force. It would appear also from ourmeasurements that this alveolar processmay be more readily held back withcervical traction in girls than in boys.

Or, it may be said that the forwardgrowth tendency in boys is greater thanin girls; that the resistive force of theneckband appliance has more to with-stand or overcome in the male. This is a different concept from thatexpressed by Silverstein who found atreatment decrease in SNA in males butnone in females. It is the opposite idea,also, from that of King who foundthe greatest change in point A in males.

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Silverstein's report included seventy-four Class I1 cases forty more thanthis sample in which it is pdthe chief reducing agents were ClassI1 elastics. King reported fifty Class 11,Division 1 cases sixteen more thanthis paperboth extraction and non-extraction with a greater age range, andsome of his cases did not have fulledgewise appliances in addition to theneckband appliance.

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On the basis of the findings in thesmaller sample reported here and withthe conclusions of Carlson and Clementsin mind that SNA increases more ingood occlusion males than females Isubmit the opinion that Cervical traction may retract orhold back forward change of the max-illary anterior alveolar process more innonextraction girls than in nonextrac-tion boys because females do not haveas much forward growth force. Some of the greater forwardgrowth force potential in boys may ex-press itself in spite of the restraint ofcervical traction. If concepts 1 and 2 should betrue, then boys, ideally, ought to wearthe neckband appliance twenty-fourhours a day, whereas the girls, havingless growth to hold back, should needto wear the appliance only twelve tofourteen hours daily.

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This might be trueif the end result of treatment was con-cerned only with reduction of point A. However, the comparatively greaterforward growth at other facial pointscompensates for this relative difficultyin restraining point A in the male.

SNB was not affected by treat-ment Silverstein observed, while Stonerand his co-workers found a mean for-ward movement of. Carlson found an increase in SNBfrom eight to seventeen years.

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This in-crease was greater than the SNA in-crease and more in males than females. Clements reported an increase in SNBin both males and females.

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It increased in eightgirls, decreased in seven and remainedthe same in two. In boys the high increase was 2",the low lo, and the mean 1. The greatestmale decrease was I", the lowest.

It increased in tengirls, decreased in five, remained thesame in two. The high increase in the boys was7 mm. Boys' greatest decrease was 2.

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The greatest decrease in the girlswas 4. Seventeen of thetotal cases decreased or stayed identicalwhile seventeen increased. The bigdiEerence was tile fact that ths meanincrease was greater than the meandecrease.

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With regard to the SB linear distancethere is a decided statistical advantageon the side of the increase. Twenty-three of the total showed an increase,while eleven decreased or stayed thesame. The increase was greater in theboys than in the girls.

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The mean de-crease was similar in the two sexes. A comparison of the of theangular and lineal measurements relatedto point B indicates that much of theforward growth of the mandibularanterior alveolar process may be mask-ed in the angular measurements by theforward growth of point N. The SBmeasurements show that B moves for-ward predominantly in both sexes butmore in boys than girls. This wouldtend to confirm the findings of Lande,Stoner et.

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It would appear likely that point Bwas affected very little, if any, by treat-ment as Silverstein noted. However,where there was a decrease in the SBdistance or where it remained the same,the bite opening effects of treatmentmay have had some influence.

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Thiswould tend to corroborate King whenhe said that such bite opening apparent-ly occurred in individuals who grewlittle or none at all, and that this open-ing remlted in a downward and back-ward displacement of the mandible. SNPQ FindingsLande found that there was an in-crease in mandibular prognathismgenerally occurring beyond seven yearsof age.

Brodie in measuring SNGn showeda predominantly forward movement ofthe chin point of three to six degrees.

Four of his nineteen cases remainedthe same. An increase in SNPo in untreatedmales and females was noted by Silver-stein.

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Stoner and his group in their linearmeasurements of point Po found that itmoved forward more than six timesfarther than point B; King concludedthat forward growth of pogonion wasdisappointing in all his treatmentgroups except nonextraction males. Present FindingsThe angle SNPo increased in ten bavs,decreased in three and remained thesame in four.

It increased in nine girls,decreased in five, and stayed the samein three. Nineteen of the entire grouphad an increase, eight had a decrease,and seven remained the same. The boys showed a high increase of3", a low of lo, and a mean of 1. The girls evidenced a high increase Vol. The three boys who showed a de-crease were identical with l" each,while the greatest decrease in the girlswas lo, the least.

The interestingfindings brought out by comparison ofthe angular and linear measurements ofpoints A and B dictate inclusion of SPoin a contemplated revision of this work. ZIP: 99518 99515 99517 99516 99513 99540 99567 99587 99508 99506 99507 99504 99505 99502 99503 99501 99577 99509 99511 99514 99520 99521 99522 99523 99524 99529 99530 99599

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