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Aim of the study was to show the effect of skeletal Class II treatment with the mandibular anterior repositioning appliance (MARA) on the sagittal posterior airway space (PAS) diameter. A total of 53 patients were selected retrospectively: 26 male patients (median 13 years, age span 10–19 years) and 27 female patients (median 14 years, age span 11–47 years). All patients had lateral cephalograms taken at T1 (before MARA treatment) and at T2 (after MARA treatment). Average treatment took 13.1 ± 7.5 months (Group 1) and 10.5 ± 4.5 months (Group 2), respectively. The following PAS parameters were obtained at T1 and T2: TI (Tangent Point 1), Me/Gn (menton/gnathion), DW (dorsal wall). Additionally, Björk‘s sum angle, SNA, SNB and ANB were determined. The male patients showed a higher increase in the anteroposterior diameter of the PAS (+27.5%) compared to female patients (+11.6%). Male participants had a significantly higher PAS (p = 0.006) than female participants (p = 0.09). Although not significantly, Björk‘s sum angle decreased in both groups. In general, compared to female patients, male patients showed a greater decrease between T1 and T2. SNA and SNB exhibited varied behavior between T1 and T2, with some individuals reporting a decrease and others reporting an increase. SNA tended to decrease in general. In terms of ANB, the male participants displayed a decrease from T1 to T2. Treatment of a skeletal Class II malocclusion with the mandibular anterior repositioning appliance (MARA) caused an increase in the sagittal posterior airway space (PAS) diameter and, thereby, might be effective against obstructive sleep apnea.

The aim of the study was to evaluate the changes in skeletal, dentoalveolar, and airway dimensions induced by the mandibular anterior repositioning appliance (MARA) in the treatment of Class II malocclusion. A group of 24 Class II patients treated with MARA was evaluated with lateral cephalograms at the start (13.8 ± 2 years) and at the end of treatment (15.7 ± 1.9 years) and compared with a matched untreated Class II group of 20 subjects selected from the archive of the AOOF Legacy. Statistical comparisons were performed with the Student’s t-test. No significant differences were observed for the sagittal airway dimensions. The MARA group showed a significant improvement of Wits (−1.4 mm; p = 0.009) and ANB angle (−0.6°; p = 0.038), a reduction in the overjet (−1.9 mm; p = 0.001), of the overbite (−1.5 mm; p = 0.005), an improvement of molar relationship (1.8 mm; p = 0.000) and a proclination of the lower incisors (2.7°; p = 0.012). During active treatment, MARA did not produce significant favorable changes in the sagittal airway dimensions in Class II subjects when compared with untreated controls. Clinically, these findings highlighted that MARA was able to provide an effective correction of Class II malocclusion with favorable dentoskeletal changes.