Effects of early activator treatment in patients with class II malocclusion evaluated by thin-plate spline analysis

The aim of the present longitudinal cephalometric study was to evaluate the dentofacial shape changes induced by activator treatment between 9.5 and 11.5 years in male Class II patients. For a rigorous morphometric analysis, a thin-plate spline analysis was performed to assess and visualize dental and skeletal craniofacial changes. Twenty male patients with a skeletal Class II malrelationship and increased overjet who had been treated at the University of Heidelberg with a modified Andresen-Häupl-type activator were compared with a control group of 15 untreated male subjects of the Belfast Growth Study. The shape changes for each group were visualized on thin-plate splines with one spline comprising all 13 landmarks to show all the craniofacial shape changes, including skeletal and dento-alveolar reactions, and a second spline based on 7 landmarks to visualize only the skeletal changes. In the activator group, the grid deformation of the total spline pointed to a strong activator-induced reduction of the overjet that was caused both by a tipping of the incisors and by a moderation of sagittal discrepancies, particularly a slight advancement of the mandible. In contrast with this, in the control group, only slight localized shape changes could be detected. Both in the 7- and 13-landmark configurations, the shape changes between the groups differed significantly at P < .001. In the present study, the morphometric approach of thin-plate spline analysis turned out to be a useful morphometric supplement to conventional cephalometrics because the complex patterns of shape change could be suggestively visualized.