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ORTHODONTICS Cite this article: Showkatbakhsh R, Jamilian A, Alipanahi M, Perillo L. Treatment Effects of RAppliance in Vertical Growing Patients-Case Series. Stoma Edu J. 2014;1(2): 102-107. TREATMENT EFFECTS OF R-APPLIANCE IN VERTICAL GROWING PATIENTS-CASE SERIES Rahman Showkatbakhsh1a, Abdolreza Jamilian2a*, Minoo Alipanahi2b, Letizia Perillo3c 1. Department of Orthodontics, Shahid Beheshti University of Medical Sciences, Tehran, Iran 2. Department of Orthodontics, Tehran Dental Branch, Craniomaxillofacial Center Islamic Azad University, Tehran, Iran 3. Departments of Orthodontics, Second University of Naples, Naples, Italy a. DDS, PhD, Associate Professor b. DDS c. DDS, PhD, Professor Abstract The purpose of this study was to evaluate the effects of a functional appliance (the R-appliance) on Class II division I vertical growth pattern patients with mandibular deficiency. Twenty patients (13 girls and 7 boys) of an average age of 10.6 (SD 0.8) years were treated with R-appliance for 16 (SD 0.4) months. All patients had Class II division 1 malocclusions due to mandibular deficiency and were vertical growers. Lateral cephalograms obtained at the beginning (T1) and at the end (T2) of the study were analyzed. Paired t-tests showed that SNB significantly increased from 72.8° (SD 2.2°) to 76° (SD 1.8°) (P<0.001) after treatment. The incisor mandibular plane angle (IMPA) significantly decreased and the Jarabak index increased for 1.7% (SD 2.5%) (P<0.007). R-appliance was successful in moving the mandible forward in vertical growth pattern patients without proclination of the lower incisors. Keywords: Functional Appliance, Class II Division 1, mandibular deficiency, R-appliance, vertical growth pattern Introduction Class II division 1 malocclusion due to mandibular deficiency is a commonly observed clinical problem (1, 2), and it has been extensively studied for skeletal and dental characteristics (3, 4). Different functional appliances have been used to treat this malocclusion (5-13). Functional appliances put the mandible in forward position, result in stretches on the related attached muscular groups of the mandible, and create bone remodeling and muscular adaptation (14-21). However, it is reported in the literature that functional appliances can cause restriction of maxillary growth (5, 22, 23). Moreover, flaring of lower incisors is another of their disadvantages (24, 25). The influence of functional appliances in the vertical relation of the bone bases is a controversial subject in literature. Most of the time, functional appliances are not recommended in vertical growth pattern patients because these appliances can cause a subsequent clockwise mandibular rotation and, consequently, may worsen the facial esthetics (18, 26). Restriction of the maxilla, proclination of lower anteriors and being unsuitable in treatment of vertical growers are the main disadvantages of traditional functional appliances. In order to overcome these disadvantages and correct vertical growth pattern patients, R-Appliance was designed. Received: 20 August 2014 Accepted: 29 October 2014 * Corresponding author: Associate Professor Abdolreza Jamilian, DDS, PhD Department of Orthodontics, Tehran Dental Branch, Islamic Azad University 2713, Vali Asr St., Tehran 1966843133, Iran Tel: 0098-21-22011892 Fax: 0098-21-22022215 e-mail: info@jamilian.net 102 Methods and Materials: Written consent was obtained from each patient or parent according to the ethical principl