Optimizing Contemporary Orthodontic Treatment using the 2×4 Appliance: Review of Techniques and Outcomes The 2×4 Appliance: Review of Techniques and Outcomes
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Abstract
With the new emphasis on timely management of malocclusions to avert the consequences of untreated malocclusion, interceptive orthodontics has both simplified, and eliminated the need for future intervention. The 2×4 appliance is a kind of fixed orthodontic appliance that is specifically indicated in the period of mixed dentition to address transitional dental problems such as anterior crossbites, open bites, deep bites, crowding, and rotations. This narrative review describes the uses, advantages, disadvantages, and the modifications of the 2×4 appliance. The databases of PubMed, Scopus, Cochrane Library, Google Scholar, and grey literature databases were searched for clinical trials, observational studies, and case reports/series looking in English using multiple searching terms. Out of 64 articles, 35 were relevant articles that screened, appraised and summarized in this review. The 2×4 appliance is indicated for mixed dentition patients who present with either mild or moderate malocclusions, especially when removable appliance compliance is a significant concern. Owing to their advantages, the usage of such appliance is recommended by orthodontists and pedodontists.
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References
1. Gandhe S, Patil AT, Sandhyarani B, Sujatha P, Prakash A, Kanetkar J. 2x4 appliances in paediatric dentistry: A Review and Case Report. Afr J Biomed Res. 2024; 27: 9394-9400.
2. Graber TM, Vanarsdall RL Jr. Orthodontics current principles and technique. 3rd ed. St. Louis: Mosby; 2000.
3. McKeown HF, Sandler J. The two by four appliance: a versatile appliance. Dent Update. 2001; 28: 496–500.
4. Dowsing P, Sandler J. How to effectively use a 2×4 appliance. J Orthod. 2004; 31: 248–258.
5. Rohilla M, Bodh M, Kumar A, Namdev R. Early interception using 2×4 appliance: a case series. Int J Advances Case Reports. 2017; 4: 226–229.
6. Solanki PJ, Choudhari SR, Vaghela CM, Saxena SI. Use of the two by four appliance: a treatment modality for the correction of malaligned maxillary anterior teeth during mixed dentition period. Int J Development Res. 2017; 7: 17729–17732.
7. Singhal P, Namdev R, Jindal A, Bodh M, Dutta, S. A multifaceted approach through two by four appliances for various malocclusions in mixed dentition. Clin Dent. 2015; 9: 14–19.
8. Arturo Garrocho-Rangel, Gabriela Hernández-García, Esthela Yáñez-González, Socorro RuizRodríguez, Miguel Rosales-Berber, Amaury Pozos-Guillén. 2 ×4 appliance in the mixed dentition stage: a scoping review of the evidence. J Clin Ped Dent. 2023; 47(1): 1-8.
9. Subramanyam D. Modified two by four appliance for single tooth anterior crossbite correction. Int J Current Adv Res. 2019; 8: 17424-17426.
10. Agarwal A, Mathur R. Segmental orthodontics for the correction of crossbites. Int J Clin Pediat Dent. 2011; 4: 43–47.
11. Soni S, Bafna Y, Choski K, Patel J, Kotadiya J. Early orthodontics interception in mixed dentition using 2×4 appliance: a series of 3 case report. J Med Sci Clin Res 2019; 7: 44-49.
12. Yordanova G, Mladenov M, Gurgurova G. Cross-bite treatment and problems during the early stages of developing of the dentition in the frontal area. Int J Sci Res. 2016; 5: 1506–1510.
13. Naidu S, Suresh A. The applications of 2×4 appliance during mixed dentition. Acta Sci Dent Sci. 2018; 2: 49–51.
14. Sockalingam SNMP, Khan KAM, Kuppusamy E. Interceptive correction of anterior crossbite using short-span wire-fixed orthodontic appliance: a report of three cases. Case Reports Dent. 2018; 2018: 1–5.
15. Shrimahalakshmi, Chowdhary N, Thimmaiah M, Peddi R, Shivanna, V. Interceptive orthodontic treatment using the versatile 2×4 appliance: A case report. Indian J Public Health Res Develop 2023; 14: 309-312.
16. Isaacson RJ, Rebellato J. Two-couple orthodontic appliance systems: torquing arches. Sem Orthod. 1995; 1: 31-36.
17. Yermalkar G S, Gaonkar N, Shashikiran N, et al. Correction of single-tooth crossbite using a 2x4 appliance: a clinical case report. Cureus. 2024; 16(10): e71818.
18. Bhalajhi SI. Orthodontics: The art and science. 3rd ed. New Delhi: Anja (Med) Publishing House; 2006.
19. Sunil MM, Zareena MA, Ratheesh MS, Anjana G. Early orthodontic interception of anterior crossbite in mixed dentition. J Int Oral Health. 2017; 9: 88–90.
20. Wiedel AP, Bondemark L. Fixed versus removable orthodontic appliances to correct anterior crossbite in the mixed dentition—a randomized controlled trial. Eur J Orthod. 2015; 37: 123-127.
21. Reyes A, Serret L, Peguero M, Tanaka O. Diagnosis and treatment of pseudo-class III malocclusion. Case Reports Dent. 2014; 2014: Article ID 652936.
22. Yanez EER. 1001 Tips’ for orthodontics and its secrets. 1st ed. Miami: AMOLCA; 2008.
23. Proffit WR, Fields HW Jr., Larson BE, Sarver D.M. Contemporary orthodontics. 6th ed. Philadelphia: Elsevier, 2019.
24. Takane VV, Keluskar KM, Shirsat S, Shetty GP. Rapid maxillary expansion in a pseudo Class III malocclusion with blocked out maxillary canines. Int J Orthod Rehabil. 2019; 10: 180-184.
25. Brito G, Simões D, Flores PS, Machado AW. An effective approach to correcting anterior crossbite in a class III patient. J Clin Orthod. 2020; 54: 705-711.
26. Buitrago DFL, Saavedra CMC. Therapeutic management of a pseudo class III malocclusion. Case report. Revista Mexicana de Ortodoncia. 2015; 3: 248-254.
27. Loli D. The versatility of the 2×4 appliance. Webmed Central Orthod. 2017; 8: WMC005397.
28. Das L, Sarkar A, Banerjee D, Adak A, Saha S, Sarkar S. Catch them young: early interception of malocclusion in mixed dentition period using 2×4 appliance. Int J Current Res. 2020; 12: 10247-10250.
29. Hussain U, Ayub A, Farhan M. Etiology and treatment of midline diastema: a review of the literature. Pakistan Orthod J. 2013; 5: 27–33.
30. Garrocho-Rangel A, Hernández-García G, Yáñez-González E, Ruiz-Harika R, Dwijendra KS, Arun P, Swetha SS. Correction of midline diastema and rotated incisors using a versatile fixed partial appliance in mixed dentition: a case report. Pediatric Dent Care. 2016; 1: 116–118.
31. Fleming P, Seehra, J. Fixed orthodontic appliances a practical guide. 1st ed. Switzerland: Springer; 2019.
32. Pokharel PR, Shrestha S. A short review of intrusion arches in orthodontics. Int J Oral Health. 2023; 3: 1‒3.
33. Bench RW, Gugino CF, Hilgers JJ. Bioprogressive therapy Part 7: The utility and sectional arches in Bioprogressive therapy mechanics. J Clin Orthod. 1978; 12: 192-207.
34. McNamara JA. Utility arches. J Clin Orthod. 1986; 20: 452-459.
35. Burstone CJ. Biomechanics of deep overbite correction. Sem Orthod. 2001; 7: 26-33.
36. Burstone CJ, Choy K. The biomechanical foundation of clinical orthodontics. 1st ed. Chicago: Quintessence Publishing Co, Inc.; 2015.
37. Nanda R, Marzban R, Kuhlberg A. The Connecticut intrusion arch. J Clin Orthod 1998; 32: 708-715.
38. Sharma S, Vora S, Pandey V. Clinical evaluation of efficacy of CIA and CNA intrusion arches. J Clin Diagnos Res. 2015; 9: ZC29-ZC33.
39. Amasyali M, Sağdiç D, Ölmez H, Akin E, Karçay P. Intrusive effects of the Connecticut intrusion arch and the utility intrusion arch. Turk J Med Sci. 2005; 35: 407-415.
40. Gu Y, Rabie AB, Hagg U. Treatment effects of a simple fixed appliance and reverse headgear in correction of anterior crossbites. Am J Orthod Dentofacial Orthop. 2000; 117: 691-699.
41. da Silva VM, Ayub PV, Massaro C, Janson G, Garib D. Comparison between clear aligners and 2×4 mechanics in the mixed dentition: a randomized clinical trial. Angle Orthod. 2023; 93: 3–10.
42. Isaacson RJ, Lindauer SJ, Rubenstein LK. Activating a 2 x 4 appliance. Angle Orthod. 1993; 63(1): 17-24.
43. Rebellato J. Two-couple orthodontic appliance systems: activations in the transverse dimension. Sem Orthod. 1995; 1: 37-43.
44. Tsui VWK, Alkhal HA, Hou HM, Wong RWK, Rabie ABM. The modified two-by-one fixed orthodontic appliance for bodily movement of canine: a case report. Cases J. 2009; 2: 211.
45. Quinzi V, Ferro R, Rizzo FA, Marranzini EM, Federici Canova F, Mummolo S, Mattei A, Marzo G. The Two by Four appliance: a nationwide cross-sectional survey. Eur J Paediatr Dent. 2018; 19(2): 145-150.