DISSERTATION – SYNOPSIS
DR. JENCY SAMUEL JOHNSON
POST GRADUATE STUDENT
DEPARTMENT OF PEDODONTICS AND PREVENTIVE DENTISTRY
K.V.G. DENTAL COLLEGE & HOSPITAL
KURUNJIBAGH, SULLIA – 574327
DAKSHINA KANNADA
BATCH OF 2012 – 2015
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
KARNATAKA, BANGALORE
ANNEXURE-II
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1.
NAME OF THE CANDIDATE DR. JENCY SAMUEL JOHNSON
AND ADDRESS
POST GRADUATE STUDENT
( IN BLOCK LETTERS)
DEPT OF PEDODONTICS AND PREVENTIVE
DENTISTRY
KVG DENTAL COLLEGE AND HOSPITAL,
SULLIA, KARNATAKA
2.
KVG DENTAL COLLEGE AND HOSPITAL,
NAME OF THE INSTITUTION
SULLIA, KARNATAKA
3.
COURSE
OF
STUDY
AND MASTER OF DENTAL SURGERY (M.D.S) IN
PEDODONTICS
SUBJECT
AND
PREVENTIVE
DENTISTRY
4.
DATE
OF
ADMISSION
TO
30-05-2012
COURSE
A COMPARATIVE EVALUATION OF THE
5.
TITLE OF THE TOPIC
DENTOSKELETAL TREATMENT EFFECTS
OF MYOFUNCTIONAL
TRAINERS
AND
TWIN BLOCK APPLIANCES ON CLASS II
DIVISION I MALOCCLUSIONS
6
BRIEF RESUME OF THE INTENDED WORK:
6.1) Need For The Study:
Most of the severe skeletal irregularities in sagittal, transversal and vertical
direction that require complicated and expensive orthodontic-surgical procedures in
adolescence could be prevented in early stage.1 In Class II Division I malocclusions, the
mandible is locked in distal position by an unfavorable distal driving occlusion that do
not favor mandibular development to the patients’ full potential of growth.2 To initiate
Class II orthopaedic therapy at an earlier age, correction of functional problems of soft
tissues such as lingual malposition, the centripetal thrust of the lips and cheeks and oral
respiration need to be the part of the goal.3
Amongst the various appliances used for correction of Class II Division I
malocclusions, conventional twin block appliances and novel pre fabricated
preorthodontic trainers has gained immense popularity. However, very little has been
reported in the scientific literature, with regard to the direct comparisons of the efficacies
of the two treatment modalities.
Twin block appliances induce supplementary lengthening of mandible by
stimulating increased growth at the condylar cartilage when constructed to a protrusive
bite with occlusal inclined plane as guiding mechanism and closes the mandible forward.
Thus, correction of class 2 malocclusion in mandibular deficiency cases can be done by
utilizing the pubertal growth spurts.2,4
Trainer System appliances exercise craniofacial system muscles to physiological
load of bones and stimulate growth and development of all craniofacial system
structures.5 Leading the facial and masticatory muscles to work properly, balancing the
forces of the tongue and cheeks by proper tongue positioning in function and at rest,
myofunctional trainers stimulate growth and development of maxilla, mandible and
dental arches including correct teeth positioning .6
Some authors demonstrated that functional appliances produce significant influence on
mandibular growth, the others claimed that it may induce only small skeletal changes and
significant dentoalveolar changes.7 Therefore the need of the present study is to analyze
the skeletal and dentoalveolar changes in Class II Division I malocclusion cases treated
with myofunctional trainers and twin block appliances and compare those alterations
experienced with an untreated age and sex matched control group.
6.2) AIM OF THE PRESENT STUDY :
a) To evaluate the maxillo-mandibular skeletal and dentoalveolar changes produced
by prefabricated preorthodontic trainer on skeletal class II division I patients.
b) To evaluate the maxillo-mandibular skeletal and dentoalveolar changes produced
by twin block on skeletal class II division I patients.
c) To compare the post treatment effects of myofunctional trainers and twin block
appliances on skeletal and dentoalveolar components of Class II division I
malocclusions.
6.3) REVIEW OF LITERATURE:
A prospective control study investigated the net effects of the twin block
appliance taking into account the effects of normal growth in an untreated control group.
The treatment group consisted of 36 subjects (11boys, 17girls) of mean age 12.4years
treated for 0.9years. Each subject had pre and post treatment lateral cephalograms taken.
The control group consisted of 27 subjects of mean age 12.1years. In the treatment group
a reduction in ANB of 2° was observed largely because of an increase in SNB of 1.9°.
The overjet was reduced by combination of a net maxillary incisor retroclination of
10.8°, net mandibular incisor proclination of 7.9° and forward movement of the
mandible. This study highlighted that twin block appliance is a very effective tool with
which skeletal and dentoalveolar change can be obtained.8
A clinical study was done to investigate the treatment effects of a twin block
appliance using Pretreatment and posttreatment cephalometric records of 28
consecutively treated patients (19male, 17 female) of mean age 9years and 1month with
Class II malocclusion and compared it with an age and sex matched sample of untreated
Class II control subjects(13male, 14female).The treatment group was treated using the
twin block appliance.Results indicated that mandibular growth in the treatment group
was on average 4.2mm greater than in the control group over the 14 month treatment
period. In addition, some dentoalveolar effects in both arches contributed to the overjet
correction. In general, the magnitude and direction of skeletal changes observed with the
appliance were found to be quite favourable9.
A case control study was done with the Twin-block appliance on 30 consecutive
patients(14male, 16female of average age 12years, 6 months) with Class II Division 1
malocclusions. A control group was generated from published normative data such that
each treated case was matched individually for age, sex, and treatment time. The
cephalometric change during treatment was compared to the natural growth change in the
matched control group. There was a statistically and clinically significant reduction in
overjet, angle ANB, increase in angle SNB, and mandibular length together with a
reduction in upper incisor angle. Thus concluding twin block to be effective in treating
both dentoalveolar and skeletal discrepencies in class II division 1 maloccusion10.
A study was done to clarify the dentoskeletal treatment effects induced by a
preorthodontic trainer appliance treatment on Class II division I cases. Twenty Caucasian
patients (10 boys and 10 girls, Mean age: 9.6 ± 1.3 years) with Class II division I
malocclusion were treated with preorthodontic trainer appliances. A control group of 20
patients (10 boys and 10 girls, Mean age: 10.2 ± 0.8 years) with untreated Class II
division I malocclusions was used to eliminate possible growth effects. Lateral
cephalograms were taken at the start and end of treatment. At the end of the study period,
the trainer group subjects showed significant changes including anterior rotation and
sagittal growth of the mandible, increased SNB and facial height, reduced ANB,
increased lower incisor proclination, retroclination of upper incisors, and overjet
reduction, concluding that, the pre orthodontic trainer application induces skeletal and
dentoalveolar changes.3
A study was done to analyze the skeletal and dentoalveolar changes in 34 Class
II Division 1 malocclusion cases (15boys, 19 girls of mean age 10years and 2months)
treated with Twin-block appliance by carrying out cephalometric evaluation before and
after treatment. Mandibular length increased by 4.6 mm in the Twin-block group
compared with 2.2 mm in the control group. ANB angle reduced by 2.3°, overjet
reduction was 4.7 mm, postnormal molar position corrected by 3.6 mm. Twin-block
appliance statistically significantly increased mandibular length by 2.4 mm during 12month treatment period. Thus concluding the efficiency of Twin-block treatment in
achieving skeletal and dentoalveolar corrections by about 40% and 60% respectively.7
A study was done to evaluate the effect of Trainer positioners - T4K on three
cephalometric variables. Thirty-four children, aged between 7 and 10 years, were
selected for the purpose for over twelve months, and radiographs were obtained, one at
the beginning and the other end of treatment. The variables: Co – A, Co – Gn and ANS –
Me, were made on cephalograms and the magnitudes were compared among the tested
group and control. The magnitudes were statistically validated and found to be
significant. It was concluded that the use of the device has no effect on the growth
restriction of the jaw, but it seems cause the increase of the effective growth of the jaw
and the vertical dimension.11
A study comprising of 50 Class II Division I patients (20 test patients and 30
untreated controls) of age group 8 – 12 years was done to evaluate cephalometrically the
treatment effects of preorthodontic trainer on dentoskeletal components in individuals
showing Class II Division I malocclusion. Standardized lateral cephalograms of both
groups were taken before and after the treatment period of 15months. The readings were
tabulated and subjected to statistical analysis. The results showed significant reduction in
overjet, increase in inclination of the mandibular incisors and vertical dimension of the
face, showing significant reduction in skeletal Class II relationship. An upward cant of
the occlusal plane in the treatment group was noted probably due to forward rotation of
mandible. The results concluded that Class II corrections can be achieved with the pre
orthodontic trainer appliance, which appears to have mostly dentoalveolar effects with
smaller but significant skeletal effects.12
6.4 OBJECTIVES OF THE STUDY:
a) To evaluate the effectiveness of pre fabricated orthodontic trainer by
comparing the skeletal and dentoalveolar changes in a group of
myofunctional orthodontic trainer treated Class II division I patients after
active phase of treatment and untreated age and gender matched control
group.
b) To evaluate the effectiveness of twin block appliance by comparing the
skeletal and dentoalveolar changes in a group of twin block treated Class II
division I patients after active phase of treatment and untreated age and
gender matched control group.
c) To compare the post treatment cephalometric changes seen with prefabricated
orthodontic trainer and twin block appliance on Class II division I
malocclusions.
7
MATERIALS AND METHODS:
7. 1) Source Of The Data:
Pre and post treatment clinical photographs, study casts, and cephalometric
radiographs of 20 children (boys and girls) of age group of 8-14 yrs having Class II
Division I malocclusion who were already treated and those diagnosed and consenting
to treatment for study purpose with prefabricated orthodontic trainer (10 cases each)
and twin block (10 cases each) will be procured from the records of Department of
Pedodontics and Preventive Dentistry and Department of Orthodontics and Dentofacial
Orthopaedics of KVG Dental College and Hospital, Sullia and centres treating similar
cases in and around South Kanara District, Karnataka.
10 untreated Class 2 Division I age and gender matched controls not willing for
removable orthodontic appliance therapy and who meet inclusion criterion will be
chosen randomly for study purpose. Written informed consent will be taken prior to the
study from their parents.
INCLUSION CRITERIA:
Study Group:
1. Class II skeletal malocclusion with orthognathic maxilla and retrognathic
mandible
2. Class II Division I dental type malocclusion
3.
Age group: 8-14 years (boys and girls of Indian descent)
4.
Positive VTO
5.
ANB angle: ≥ 30
6.
Average to horizontal growth pattern
7. Over jet: ≥ 4.5mm with protrusion of maxillary central incisors
8. Occlusion criteria: Mixed dentition and early permanent dentition
9. Informed consent from parents
Control Group :
1. Untreated age and gender matched Class II division I patients not willing for
removable orthodontic appliance therapy.
(The subjects in the control group will only be included in the study after
obtaining written informed consent when they refuse orthodontic treatment.)
EXCLUSION CRITERIA:
1. Medically compromised patients
2. Cases with congenital syndromes
3. Cases with obvious asymmetry
4. Patients with history of previous orthodontic treatment or surgical correction of
maxilla-mandibular relationships.
5. Patients with history of thumbsucking habits
6. Patients with severe nasal obstruction
7. Patients with improper compliance or discontinued use of appliance during the
tenure of the study.
7.2) Method Of Collecting Data :
Cephalometric radiographs of 20 children (boys and girls) of age group of 8-14 yrs
having Class II Division I patients who were treated and those diagnosed and
consenting for treatment with prefabricated orthodontic trainer (10 cases each) and twin
block (10 cases each) will be procured from the records of Department of Pedodontics
and Preventive Dentistry and Department of Orthodontics of KVG Dental College and
Hospital, Sullia and centres treating similar cases in and around South Kanara District,
Karnataka.
10 untreated Class 2 Division I age and gender matched controls who meet inclusion
criterion will be chosen randomly for study purpose. Written informed consent will be
taken prior to the study from their parents.
1. Instruments and materials that will be used during the study:
1. Standardized lateral cephalograph films
2. Maxillary and mandibular dentulous metallic stock impression trays
3. Irreversible hydrocolloid Alginate impression material
4. ADA Type III dental stone
2. Methodology:
30 subjects (15 boys and 15 girls) in the age groups 8 – 14 years will be selected and
divided into three groups.
GROUP I – 10 Class II Division I patients (5 boys , 5girls) treated with
prefabricated orthodontic trainer
GROUP II – 10 Class II Division I patients (5 boys , 5girls) treated with
twin block appliances
GROUP III – 10 untreated Class II division I (5 boys, 5girls) control
group.
Detailed Case history of each subject who meets the inclusion criterion of the specific
groups will be obtained after explaining the procedure and after obtaining consent.
Alginate impressions of maxillary and mandibular teeth will be made for each subjects
using metallic stock trays and poured in type III dental stone.
The lateral cephalograms will be obtained at the start and end of the treatment. The final
cephalograms of all the patients in control and experimental group will be taken at the
end of 8-12 months period of the study.
All cephalometric radiographs will be traced on matte acetate tracing paper in a random
order by a single investigator using 3HB pencil inorder to reduce bias.
3. Collection of data:
28 landmarks will be identified on each lateral cephalogram and grouped as follows:
S. NO
ANGULAR SKELETAL LINEAR SKELETAL DENTAL
MEASUREMENTS
MEASUREMENTS
MEASUREMENTS
1
SNA ( )
N – Me
U1 – NA(mm)
2
SNB (0)
S – Go
U1 – NA (0)
3
ANB (0)
Go – Ar
U1 – SN (0)
4
NA – Pog (0)
Co – Gn
L1 – NB (mm)
5
SN – GoGn ( )
Go – Me
L1 – NB (0)
6
N – S – Ar (0)
IMPA (0)
7
S – Ar – Go (0)
Inter – incisal angle
8
Ar – Go – Me (0)
Overjet (mm)
9
FH – MP ( )
Overbite (mm)
10
PP – MP (0)
Maxillary
0
0
0
molar
position
11
OP – SN (0)
Mandibular
position
12
Me – Go – S (0)
molar
PLANES AND ANGLES:
1. Angle SNA: To determine whether maxilla is positioned anterior or posterior to
cranial base.
2. Angle SNB: To determine whether mandible is anterior or posterior to cranial
base
3. Angle ANB: To determine the relative position of jaws to each other.
4. Angle NA – Pog (Angle of Convexity): Measures the degree of maxillary basal
arch at its anterior limit (point A) relative to total facial profile (Nasion –
Pogonion).
5. Angle SN – GoGn (Mandibular plane angle): Measures the relation of the
mandibular plane to anterior cranial base indicating the growth pattern of the
individual.
6. Angle N – S – Ar: Saddle angle
7. Angle S – Ar – Go: Articular angle
8. Angle Ar – Go – Me : Gonial angle
9. Angle FH – Mandibular plane angle: indicates unfavorable hypo or
hyperdivergent facial patterns.
10. Angle PP – MP: Maxillo mandibular plane angle.
11. Angle OP – SN: Measures the occlusion of teeth in relation to the face and the
skull.
12. Anterior facial height (N-Me) : To check for facial growth pattern of subjects
(Horizontal or vertical)
13. Posterior facial height (S-Go) : To check for facial growth pattern of subjects
(Horizontal or vertical)
14. Ramus height (Go – Ar): To measure the height of the ramus.
15. Mandibular unit length (Co – Gn): To determine the linear growth of mandible.
16. Mandibular body length (Go – Me): To determine the linear growth of mandible
17. U1 – NA (mm) and (0): Indicates the relative angular and linear measurements
of upper incisor teeth to the facial skeleton.
18. U1 – SN (0): Indicates the relative angular position of the upper incisor to the
cranial base.
19. L1 – NB (mm) and (0): Indicates the relative angular and linear measurements
of lower incisor teeth to the facial skeleton.
20. Angle IMPA: To determine the inclination of the lower incisor teeth in relation
to the mandibular plane.
21. Interincisal angle: To know the inclination of the upper and lower incisor teeth
relative to each other.
22. Overjet: To determine the horizontal overlap of maxillary and mandibular
anterior teeth.
23. Overbite: To determine the vertical overlap of maxillary and mandibular
anterior teeth
24. Maxillary molar position : To check for occlusion
25. Mandibular molar position : To check for occlusion
All the angles and linear parameters of pre and post treatment lateral cephalometric
radiographs will be measured.
The mean and standard deviation will be calculated for each cephalometric variable. The
data will be tabulated and comparison of T1 and T2 readings will be statistically analyzed.
Pre and post mean values will be subtracted to obtain the net change achieved. Thus for
each set of pretreatment and post treatment cephalometric measurements taken from the
patient, an equivalent set will be obtained from the controls matched for age and sex.
To determine the accuracy of the cephalometric measurements, 10 cephalograms will be
randomly selected and retraced after a period of 20 days. A paired t test will be applied to
the first and second measurements and the difference will be analysed statistically.
All statistical analyses will be performed using the Statistical Package for the Social
Sciences for Windows software package (SPSS for Windows, version 17.0, SPSS Inc ).
4. Statistical Analysis:
The results thus obtained will be statistically analyzed using
1. Paired Student ‘t’ test to compare the mean differences between pretreatment and
post treatment measurements of preorthodontic trainer and twin block appliance
groups and the first and second observation period measurements for the control
group.
2. One way ANOVA to determine whether there are any significant differences
between the means of three independent (unrelated) groups.
3. TUKEYS test to analyze simultaneously the pair wise comparison and determine
which treatment effect is statistically significant than the other.
7.3 Does the study require any investigation or intervention to be conducted on
patients or other human or animal? If so, please describe briefly.
Yes. The study requires lateral cephalograms of Class II Division I malocclusion
patients as a part of investigation.
7.4 Has ethical clearance been obtained in case of above?
Yes. Copy of the ethical clearance is enclosed.
LIST OF REFERENCES:
1. Patti A, Perrier D’ARC G. Clinical Success in Early Orthodontic Treatment. Paris:
Quintessence Books; 2009.
2. Clark WJ. Twins block functional therapy- Applications in dentofacial
orthopaedics. 2nd ed. Spain: Mosby; 2002.
3. Usumez S, Uysal T, Sari Z, Basciftci, Karaman AI, Guray E. The Effects of Early
Preorthodontic Trainer Treatment on Class II Division 1 Patients. Angle Orthod
2004; 74:605–609.
4. Tiziano Baccetti, Lorenzo Franchi, Linda Ratner Toth and James Mcnamara Jr.
Treatment timing for twin block therapy. Am J Orthod Dentofacial Orthop. 2000;
118:159 – 170.
5. Aleksić E, Lalić M, Milic J, Gajic M, Milovanović MM, Stojanović Z et al. Trainer
System Appliances in Early Treatment of Malocclusions. Serbian Dental Journal.
2012; 59(2):96 – 100.
6. Ramirez-Yanez GO. The Trainer System in the context of treating malocclusions.
Part 1. Ortho Tribune. 2009.
7. Antanas Šidlauskas. The effects of the Twin-block appliance treatment on the
skeletal and dentoalveolar changes in Class II Division 1 malocclusion. Medicina
(Kaunas) 2005; 41(5)
8. Lund DI, Sandler PJ. The effects of twin blocks: A prospective controlled study.
Am J Orthod Dentofacial Orthop 1998;113:104-10.
9. Mills CM, McCulloch KJ. Treatment effects of the twin block appliance: A
cephalometric study. Am J Orthod Dentofacial Orthop 1998;114:15-24.
10. Trenouth MJ. Cephalometric evaluation of the twin block appliance in the treatment
of Class II division I malocclusion with matched normative growth data. Am J
Orthod Dentofacial Orthop 2000; 117:54-9.
11. Oliveira Jr EB, Nouer PR, Almeida RC, Nogueira FF, Yanez GO. Cephalometric
assessment of patients after treatment with Trainer positioners - T4K. J Br Orthod
Orthop Facial 2005; 10 (56):179-85.
12. Das UM, Reddy D. Treatment effects produced by preorthodontic trainer appliance
in patients with Class II Division I malocclusion. J Indian Soc Pedod Prevent Dent
2010 Jan-Mar; 28(1): 30 – 33.
9
Signature of the Candidate
10
Remarks of Guide
.
11.
11.1) Name and designation of
Guide (in block letters)
Dr. SAVITHA N. S., MDS
SENIOR PROFESSOR & HOD,
DEPARTMENT OF PEDODONTICS
KVG DENTAL COLLEGE AND
HOSPITAL SULLIA
11.2) Signature of the Guide
11.3) Head of Department
Dr. SAVITHA N. S., MDS
SENIOR PROFESSOR & HOD,
DEPARTMENT OF PEDODONTICS
KVG DENTAL COLLEGE AND HOSPITAL
SULLIA
11.4) Signature of Head of the
Department
12.
PRINCIPAL
Dr. MOKSHA NAYAK, M.D.S.
PRINCIPAL
K.V.G. DENTAL COLLEGE AND HOSPITAL,
KURUNJIBAGH, SULLIA.
12.1 Remark
12.2 Signature and official seal
K. V. G. DENTAL COLLEGE & HOSPITAL
KURUNJIBAGH - 574 327, SULLlA, D. K., KARNATAKA, INDIA
SPONSORED BY ACADEMY OF LIBERAL EDUCATION (REGD.) SULLIA
Department of Pedodontics and Preventive Dentistry
CONSENT FORM
Name of the Participant: ____________________________________________
Name of the Parent: _______________________________________________
Name of the Investigator: ___________________________________________
Name of the Institution: ____________________________________________
INFORMED CONSENT FOR PARTICIPATION IN RESEARCH
I, Dr. JENCY SAMUEL JOHNSON, Post Graduate Student in Department of Pedodontics
And Preventive Dentistry, am conducting a dissertation work for award of M.D.S degree in
Pedodontics and Preventive Dentistry.
The
topic
for
the
study
A
COMPARATIVE
EVALUATION
OF
THE
DENTOSKELETAL TREATMENT EFFECTS OF MYOFUNCTIONAL TRAINERS
AND TWIN BLOCK APPLIANCES ON CLASS II DIVISION I MALOCCLUSIONS.
AIMS AND OBJECTIVES OF THE STUDY:
1. To evaluate the effectiveness of pre fabricated orthodontic trainer by comparing the
skeletal and dentoalveolar changes in a group of myofunctional orthodontic trainer
treated Class II division I patients after active phase of treatment and untreated age and
gender matched control group.
2. To evaluate the effectiveness of twin block appliance by comparing the skeletal and
dentoalveolar changes in a group of twin block treated Class II division I patients after
active phase of treatment and untreated age and gender matched control group.
3. To compare the post treatment cephalometric changes seen with prefabricated
orthodontic trainer and twin block appliance on Class II division I malocclusions.
MR/MS________________________________ , we are requesting you to enrol your child
in the study conducted by Dr Jency Samuel Johnson, Post Graduate Student in department of
Pedodontics And Preventive Dentistry under the guidance of Dr. Savitha N. S MDS at K. V.
G. Dental College & Hospital, Sullia D.K.
Your child has been requested to participate. During the study you will be asked some
questions and you are supposed to answer them to the best of your knowledge.
•
Your child’s participation in research is voluntary. Your decision whether to
participate your child will not affect your relationship with K. V. G. DENTAL
COLLEGE & HOSPITAL. If you decide not to do so, you are free to withdraw
him/her at any time. The purpose of research is to ANALYSE AND COMARE THE
EFFECTS OF THE PREFABRICATED ORTHODONTIC TRAINER AND TWINBLOCK
APPLIANCE
TREATMENT
ON
THE
SKELETAL
AND
DENTOLAVEOLAR CHANGES IN CLASS II DIVISION I MALOCCLUSIONS
PROCEDURE INVOLVED:
If you agree to participate in this research study we would ask you, your child’s past, present
and family history. After detailed clinical examination and routine investigations your child
will be treated conservatively or surgically depending upon the need.
RISK AND BENEFITS:
There may be risks involved in treatment either during treatment conservatively, or
anaesthesia, or operation and during the post operative period. If any complications occur
during the operation or during the post operative period, your child will be treated with best
of our knowledge. There is no compensation or payment for such medical treatment.
ALTERNATIVES:
Even if you decline your child’s participation in the study, your child will get the routine line
of management.
PRIVACY AND CONFIDENTIALITY:
The only people to know that you are a research subject are members of the research team.
No information about you or provided by you regarding your child during the research will
be disclosed to others without your written permission except:
1. In emergency to protect your rights and welfare.
2. If required by law.
AUTHORIZATION TO PUBLISH RESULTS:
When the results of the research are published or discussed, in a conference, no information
will be displayed that would disclose your identity. Any information that is obtained in a
connection with this study and that can be identified with you will remain confidential.
FINANCIAL INCENTIVES FOR PARTICIPATION:
You will not be paid/offered any free gifts for participating in the research. You will not be
reimbursed for expenses.
ETHICAL COMMITTEE CLEARANCE
1.TTILE OF
DISSERTATION
A COMPARATIVE EVALUATION OF THE
DENTOSKELETAL TREATMENT EFFECTS OF
MYOFUNCTIONAL TRAINERS AND TWIN BLOCK
APPLIANCES ON CLASS II DIVISION I
MALOCCLUSIONS.
2.NAME OF THE
CANDIDATE
DR. JENCY SAMUEL JOHNSON
3.NAME OF THE
GUIDE
DR. SAVITHA N. S.
4.APPROVED / NOT
APPROVED
APPROVED
LAW EXPERT
PRINCIPAL
K.V.G DENTAL COLLEGE AND HOSPITAL ,SULLIA