Orthodontics

TREATMENT OF GROWING PATIENTS WITH ANDRESEN

ACTIVATORS. A CASE REPORT

Tinela PANAITE1, Daniel OLTEANU1, Bogdan DRAGOMIR2

Resident, „Gr. T. Popa” University of Medicine and Pharmacy, Iaşi, Romania

1

2
Univ. Assist. PhD, „Gr. T. Popa” University of Medicine and Pharmacy, Iaşi, Romania
Corresponding author: Tinela Panaite; e-mail: tinelap@yahoo.com

Abstract backward and transfers the force to the maxilla,

The purpose of this case report was to investigate the
clinical effectiveness in reducing large overjet with an
Andresen activator, a cheap and effective appliance for
growing patients cases. Treatment with Andresen
appliances showed a higher reduction for the ANB angle.
Conclusions: the period of orthodontic treatment was
reduced because the peak of bones’ growth occurred
concomitantly with the eruption of the second molar.
Keywords: Angle Class II Malocclusion, Andresen activators,
growing patient.
1. INTRODUCTION
which is essentially the anchorage unit for the
anteriorly displaced mandible [3]. The literature
provides a large number of studies investigating
the effects of activator’s appliance and the
response to the treatment [4]. The activator
consists of acrylic components and wire
components. All removable orthodontic
appliances are composed of porous materials in
which microorganisms infiltrate, attach and can
form biofilms [5].

Class II malocclusion is the most  prevalent
arch malrelationship in Caucasian
populations, affecting 15% up to 27%
of  its people [1]. Modifications are necessary
when the patient has unbalanced growth between
the upper and lower jaws. This type of treatment
can be applied only to patients who are still
growing. Correction of a Class II division 1
malocclusion with functional appliances is a
common treatment approach in young patients
[2]. The activator, a widely used functional
appliance, prevents the mandible from sliding
2. CASE REPORT
The case report describes the orthodontic
treatment of an 11 year-old male patient, with an
uncrowded Class II division 1 malocclusion,
presenting a good archform and a full unit distal
occlusion during the second transitional period
of mixed dentition, who addressed the clinic
with the main complaint of having excessively
protruded teeth (Fig. 1). Clinical examination
revealed a satisfactory hygiene and a low caries
prevalence.

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 TREATMENT OF GROWTH PACIENT WITH ANDRESEN ACTIVATORS: CASE REPORT

Fig. 1. Facial and intraoral initial pictures

Patient’s face presented muscle hypotonia
and an everted lower lip. The patient also
lacked passive lip closure (5.0 mm), and a
rather hypotonic upper lip. His lower lip was
both hypotonic and everted. Although the
profile was quite slightly convex, the
naso-labial angle was normal and the smile
line was tending from normal to high. Intraoral
assessment (Fig. 1) revealed a Class II division
1 malocclusion, 8 mm overjet, increased
overbite and deep bite. Lower midline was 2
mm shifted fowards right.

Fig. 2. Lateral cephalometric tracing, before the treatment, Steiner analysis

International Journal of Medical Dentistry 55

Tinela PANAITE, Daniel OLTEANU, Bogdan DRAGOMIR
Cephalometric assessment (Fig. 2) and the
values measured during the treatment revealed
a severe Class II skeletal pattern (ANB = 5o), with
a retrognatic mandible (SNA = 79o, SNB = 74o).
A counterclockwise rotation tendency was
observed in patient’s profile (SNGoGn= 31o).
Upper and lower incisors were proclined
(Interincisal angle = 122o), with increased axial
inclination (I/NA = 39o; i/ NB = 14o). The
increased overjet was due to the presence of a
signifcant skeletal class II  discrepancy, caused
primarily by mandibular retrognathia. As a
Fig. 3. Intraoral picture with Andersen appliance
3. RESULTS AND DISCUSSION
Teeth have been reported as the fourth most
common feature causing unfavourable social
56
result of a retrognathic mandible and reduced
vertical facial proportions, there is a lip catch, the
lower lip lying habitually behind the upper
incisors.
Treatment plan
Functional correction of Class I occlusion by
means of combined maxillary retraction and
mandibular advancement, with reduction of
overjet and overbite values using the Andresen
appliances for correction of uncrowded Class II
division 1 malocclusion (Fig. 3).
responses, including bullying. overjet is related
to teasing and reduced self-concept [6,7]. Overjet
reduction (Fig. 4) was Increased significant
during the 17 month-active treatment period.
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 TREATMENT OF GROWTH PACIENT WITH ANDRESEN ACTIVATORS: CASE REPORT

Fig. 4. Facial and intraoral pictures after the treatment

Fig. 5. Lateral cephalometric tracing after the treatmet, Steiner analysis

The antero-posterior skeletal pattern has
improved, the maxilla has been restrained, the
mandible has come forward and the ANB angle
was reduced (Fig. 5). The lower facial profile
was considerably improved and lip catch
disappered. The upper incisors have been
proclined and the lower incisors retroclined,
along with a decrease in the SNMP angle value.
This functional stage treatment with Andresen
appliance efficiently reduced the overjet, so
than fixed appliances are effective in finishing
the case.

International Journal of Medical Dentistry 57

Tinela PANAITE, Daniel OLTEANU, Bogdan DRAGOMIR
4. CONCLUSIONS
This present study suggests that class II
corrections can be achieved with the Andresen
appliance. This appliance appears to have mostly
dentoalveolar effects with smaller but significant
skeletal effects.
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Success rate and efficiency of activator treatment.
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3. Hirzel HC, Grewe JM. Activators: a practical
approach. Am J Orthod. 1974;66(5):557-70
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4. Wheeler TT, McGorray SP, Dolce C, Taylor MG,
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Procedia Soc Behav Sci. 2013;78:481-5.
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