Next Article in Journal
CSEM Optimization Using the Correspondence Principle
Previous Article in Journal
Enhanced FMEA Methodology for Evaluating Mobile Learning Platforms Using Grey Relational Analysis and Fuzzy AHP
 
 
Search for Articles:
Title / Keyword
Author / Affiliation / Email
Journal
Article Type
 
 
Advanced Search
 
Section
Special Issue
Volume
Issue
Number
Page
 
Journals
Applied Sciences
Volume 14
Issue 19
10.3390/app14198845
applsci-logo
Submit to this Journal Review for this Journal Propose a Special Issue
► Article Menu

Article Menu

share Share announcement Help format_quote Cite question_answer Discuss in SciProfiles thumb_up
...
Endorse textsms
...
Comment
first_page
settings
Order Article Reprints
Font Type:
Arial Georgia Verdana
Font Size:
Aa Aa Aa
Line Spacing:
Column Width:
Background:
Article

Three-Dimensional Assessment of the Effects of Kinesio Taping on Mandibular Condylar Volume with Skeletal Class II Malocclusions

by
Merve Bolukbasi
1,
Baris Baser
1,*,
Selcuk Akkaya
2 and
Nihan Ozunlu Pekyavas
3
1
Department of Orthodontics, Faculty of Dentistry, Karadeniz Technical University, Trabzon 61080, Turkey
2
Department of Radiology, Faculty of Medicine, Karadeniz Technical University, Trabzon 61080, Turkey
3
Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Baskent University, Ankara 06690, Turkey
*
Author to whom correspondence should be addressed.
Appl. Sci. 2024, 14(19), 8845; https://doi.org/10.3390/app14198845
Submission received: 9 August 2024 / Revised: 20 September 2024 / Accepted: 27 September 2024 / Published: 1 October 2024
(This article belongs to the Section Applied Dentistry and Oral Sciences)
Browse Figures
Versions Notes

Abstract

:
This study aimed to perform a three-dimensional assessment of the effects of Kinesio taping (KT) on mandibular condylar volume during Twin Block (TB) appliance therapy in individuals with skeletal Class II malocclusions. Thirty children (16 female, 14 male) aged between 10 and 15 years (12.80 ± 1.08) who were scheduled for TB therapy were randomly assigned to two groups of 15 patients each. One group (Group 1) received KT on the temporomandibular joint (TMJ) area with TB therapy while the other group (Group 2) only received the TB. KT was applied in cycles of 3 days, followed by 1 day off for 3 months. All patients underwent computed tomography (CT) scanning before KT and TB therapy (T0) and 3 months later (T1). Changes in right and left condylar volumes were measured (cm3) using a GE Advantage Workstation (General Electric Medical Systems, USA) and compared between the two groups using the Mann–Whitney U test and Wilcoxon signed-rank test. The KT group showed a significant differences in condylar volumes for both right (mean 0.13; p = 0.015; [0.04: 0.22]) and left condyle (0.30; p = 0.001; [0.18: 0.42]) from baseline (T0) to 3 months (T1). The comparisons between Group 1 and Group 2 revealed no statistically significant difference in initial and final condylar volumes for both the right (0.13; p > 0.05; [−0.16: 0.09]) and the left condyle (0.30; p > 0.05; [−0.04: 0.42]). Kinesio taping, which demonstrated a relative and slight increase on condylar volume, may provide clinical benefits such as a reduction in the duration of functional appliance use, decreased risk of relapse, and effective correction of overjet.

1. Introduction

Functional appliances used in the correction of Class II malocclusions are demonstrated to modify the neuromuscular environment of the dentition and surrounding skeletal structure [1,2]. In growing patients, a two-phase approach to managing Class II skeletal malocclusions—consisting of an initial growth modification using functional appliances followed by subsequent treatment with fixed appliances—has been recommended as an effective treatment strategy [3,4]. For patients with skeletal Class II malocclusions who are still growing, growth modification should be regarded as the primary option for the correction of skeletal deformity [5]. One of the most widely used functional appliances for orthopedic correction of Class II skeletal malocclusions is the Twin Block (TB). Due to its simple design and ease of use, the TB can be worn 24 h a day and takes full advantage of all the functional forces applied to the dentition, including those of mastication [6]. An additional benefit of the Twin Block (TB) appliance is its compatibility with fixed appliances [7]. There are studies in the literature showing the clinical and psychological effects of the Twin Block and functional appliances. A review comparing early treatment with a functional appliance versus late treatment revealed that early intervention resulted in greater reductions in both the overjet and ANB angle, favoring the use of functional appliances [8]. The same review also reported that early intervention with functional appliances was associated with a reduced incidence of incisal trauma compared to late treatment [8]. Similarly, another review established a correlation between increased overjet and the incidence of traumatic dental injuries [9]. Children with an overjet greater than 3 mm are at a higher risk of suffering traumatic dental injuries [9]. Another study assessing the psychological effects of Twin Block (TB) therapy found that children who received early orthodontic treatment with the TB reported higher self-concept scores and more positive childhood experiences compared to the control group that did not receive orthodontic treatment [10]. The second article of this study indicates that patients who received TB therapy perceived changes in their speech and sleep patterns [11].
Skeletal Class II malocclusions are usually caused by mandibular retrognathia [12], and their orthopedic treatment involves the use of fixed or removable functional appliances that modify the amount and direction of jaw growth [13]. When modifying growth, functional appliances predominantly focus on the temporomandibular joint (TMJ) region [14]. Although the mechanism of action of these appliances on condylar growth remains unclear, they may induce adaptive changes in the condylar cartilage or glenoid fossa [15].
The most common concern for patients undergoing functional appliance therapy is the long duration of treatment [16]. For physicians, the concern is the efficacy of functional therapy and post-treatment relapse. Thus, functional therapy aims to stimulate optimal cellular activity in the condyle over a short treatment period. In this context, novel non-invasive approaches that induce mandibular growth in a short period of time without causing any adverse effects are required. At present, advances in science and technology allow orthodontists to accelerate condylar cartilage growth [17]. Some researchers have considered innovative methods of laser and ultrasound applications to stimulate condylar growth, with or without functional appliances [18]. One of these innovative methods is Kinesio taping (KT), which is now widely used by athletic trainers, physiotherapists, and physicians. This non-invasive technique was developed in 1970 as an alternative to athletic taping, which is used to support the fasciae, muscles, and joints by acting on the skin on which it is applied. KT lifts the upper layer of the skin, which increases the interstitial space and thus improves blood and lymphatic circulation [19], thereby reducing inflammation [19]. Reduced pressure on the nociceptors leads to pain relief and thus increases the range of motion and freedom of the joint. Moreover, KT stimulates and strengthens the muscles and achieves correct joint alignment [19]. However, the mechanisms underlying these effects of KT remain unclear.
TMJ adaptations following functional therapies have been assessed using cephalometric and panoramic radiography. However, cephalometric and panoramic radiographs are inadequate in determining the asymmetric relationship between the two TMJs in the sagittal plane, differences in volume and form of the condyles, variations between the incline and height of the articular eminence, and the position of condyles in the glenoid fossa [20]. A computed tomography (CT) scan of the TMJ, which is a three-dimensional modality that produces clear images of the hard tissues, is the most accurate technique for assessing the volume and dimension of the mandibular condyle [21].
KT applications are becoming increasingly popular in dentistry. They were used in bruxism and TMJ dysfunction after surgical procedures [22] and impacted third molar surgery and open reduction in mandibular fractures [23], yielding positive results. Despite extensive research on KT, its use in the maxillofacial region is restricted to evaluate the effects on post-operative symptoms due to maxillofacial surgery [24]. So, the knowledge regarding the potential effects of KT on the TMJ is limited, and there is no study investigating the effects of KT on mandibular condylar volume during functional therapy in growing patients.
Thus, in this study, we aimed to evaluate possible condylar volume changes in the KT-applied group, and we used CT to assess the effects of KT on mandibular condyles during the Twin Block (TB) appliance.

2. Materials and Methods

This study received ethical approval from the ethics committee of the Karadeniz Technical University Faculty of Medicine (30.12.2021/353). All patients and their parents provided informed consent after receiving information on the purpose of this study and the treatment method.
This study was designed as a prospective, parallel-group, clinical controlled trial and was conducted on patients who were scheduled to the Karadeniz Technical University School of Dentistry, Department of Orthodontics. Patients were selected based on the following inclusion criteria:
  • ANB > 4°,
  • Mandibular retrognathia,
  • Convex profile,
  • Class II division 1 dental malocclusion,
  • Skeletal maturity varied between the CS2 and CS3 stages according to the Cervical Vertebral Maturation (CVM) index.
Exclusion criteria were as follows:
  • Patients with TMJ pain or dysfunction,
  • Craniofacial abnormalities,
  • Limited mouth opening,
  • Class II division 2 dental malocclusion,
  • Significant mandibular asymmetry were excluded.
The patients were designated into two groups of 15 patients each, with a single sequence of random assignments to achieve an equal distribution of boys and girls. One group received TB therapy combined with KT on the TMJ area (Group I), and the other received only TB therapy (Group II). A flowchart of patients in study is illustrated in Figure 1.

2.1. Sample Size Calculation

The sample size calculation was carried out based on a study conducted by Hameed Mohamed [18] by taking into consideration the mandibular condylar volume levels with alpha error = 0.05, beta error = 0.20, and effect size = 0.8. According to the sample size calculation, each group should comprise 12 participants, with a total of 24 participants. However, considering a 20% possible data drop-out, the present study included 30 patients.

2.2. Twin Block and Kinesio Tape Applying

For the TB appliance (Figure 2), a closed-mouth impression was made to bring the mandible forward by 4–6 mm. The TB appliance comprised both maxillary and mandibular removable components, retained with Adams clasps on the first permanent molars and first premolars. For enhanced retention, 0.7 mm ball clasps were employed in the interproximal areas of the mandibular incisors. A reactivation of the blocks was performed as needed. Although an expansion screw was added to the upper appliances of patients with maxillary transverse deficiency, it was not activated during this study. The patients were asked to wear their appliances all day, except during meals.
Kinesio Tex® Gold (Kinesio Holding Corporation, Albuquerque, NM, USA), 5 cm wide, was used as the taping material. Prior to application, the skin was cleaned with alcohol to remove oil, lotion, and moisture, which may limit the adhesive’s attachment to the skin. If necessary, the area to be treated was shaved. The patients and the parents were warned about possible allergic reactions that may occur, and those showing symptoms were instructed to contact us the following day. The KT protocol was performed on the TMJ area with assistance from a specialized physiotherapist using the “Star Space Correction” technique (Figure 3) [25]. The beige-colored tape was applied by a single physician, and during the first session, the patients’ parents were given a hands-on demonstration. The tape was cut into four equal pieces (2.5 cm wide and 5 cm long) with the help of the grid lines on the back. The first piece was applied vertically from top to bottom, the second piece was applied horizontally from the tragus to the nasal wings, and the remaining two pieces were applied crosswise. It was performed with 10–25% of the maximum tension of the Kinesio tape [25]. This application resulted in nearly 100% tension in the entire region. Patients received KT cycles comprising 3 days of KT followed by a 1-day break over 3 months. The patients received the KT therapy full-time during the 3-day periods.

2.3. Imaging the Condyle

The CT examinations were performed using a 64-detector 128-slice GE Revolution EVO scanner (GE Healthcare, Milwaukee, WI, USA) before and after 3 months of treatment. The scanning area was planned to cover the TMJ and the mandible. CT acquisition parameters were as follows: rotation time, 0.4 s; 80 kVp; 100 mA; slice thickness, 0.625 mm; slice interval, 0.625 mm; and pitch, 0.984. Scanning was performed using automatic tube current modulation (in three axes) and iterative reconstruction (ASIR-V) to reduce noise and dose. Acquired Digital Imaging and Communications in Medicine (DICOM) images were sent to a workstation (GE Advantage Workstation, General Electric Medical Systems, Milwaukee, WI, USA) to create three-dimensional images consisting only of bony structures.
An initial tracing intersecting the orbitale and porion points was made to isolate the condylar image. This step was followed by tracings parallel to the first one, which extended from the top of the condyle and the bottom of the sigmoid notch. The remaining surrounding structures were removed using various shaping tools, and a three-dimensional image of the condyle was obtained (Figure 4).

2.4. Statistical Analysis

The study data were analyzed using the Number Cruncher Statistical System (NCSS) 2020 Statistical Software (version 20.0.3) (NCSS LLC, Kaysville, UT, USA). Quantitative variables were shown with mean, standard deviation, medians, minimum and maximum values, and qualitative variables were shown with descriptive statistical methods such as frequency or percentage. The data were checked for normality of distribution using the Shapiro–Wilk test and box plot graphs. Given that the number of participants was insufficient for parametric testing, a non-parametric Mann–Whitney U-test was performed to compare patient characteristics between the groups for non-normally distributed variables. Intragroup analyses were performed using the Wilcoxon signed-rank test. The qualitative data were compared using the Chi-square test. The effect size was calculated according to the formula [26] below (Figure 5) and also classified as 0–0.2, very low; 0.2–0.5, low; 0.5–0.8, medium; and 0.8 and above, high, according to a previous study [27]. The results were assessed at a 95% confidence interval, and the significance was set at p < 0.05.

3. Results

In the later stages of this study, one patient who failed to cooperate was excluded from Group II. The KT group comprised eight girls and seven boys with a mean age of 12.8 ± 0.9 years, and the non-taping group comprised eight girls and six boys with a mean age of 12.82 ± 1.21 years. No significant difference was noted between-group in age and gender distribution (p > 0.05). The patients’ demographic characteristics and between-group comparisons are summarized in Table 1.
The difference between the initial (T0) and final (T1) condylar volumes in both right and left condyles of patients from Group 1 and Group 2 was not statistically significant (p > 0.05).
The changes in condylar volumes from baseline (T0) to 3 months (T1) in patients from Group 1 were found to be statistically significant for both right (p = 0.015, p < 0.05) and left (p = 0.001) condyles. Similarly, the changes in condylar volumes in the non-taping group (Group 2) were statistically significant for both right (p = 0.008, p < 0.05) and left (p = 0.019, p < 0.05) condyles between the baseline and the 3-month follow-up.
When comparing the changes in initial and final condylar volumes between the patients in Group 1 and Group 2, the results for the right condyle were not found to be statistically significant (p > 0.05). Correspondingly, when comparing the initial (T0) and final (T1) condylar volume changes between the Kinesio tape and non-taping groups, the results for the left condyle did not reach statistical significance as with the right condyle (p > 0.05). The comparison of right and left condyle volume by group are shown in Table 2 and Table 3. The initial and final changes in the right and left condylar volumes are also demonstrated in Figure 6 and Figure 7.

4. Discussion

This study investigated the effect of KT on condylar volume in patients receiving TB therapy. The results indicated that KT had no statistically significant effect, but it did have a relative and slight increase on TB therapy.
Most animal studies demonstrated that bringing the mandible forward increases the thickness of the hypertrophic cartilage of the condyle [28]. Recent clinical studies also showed that TB therapy increases the condylar volume [29]. Theoretically, the TB appliance moves the condylar head away from the glenoid fossa, which stretches the muscles and stimulates endochondral growth in the growing condylar cartilage [30]. This growth is stimulated by four masticatory muscles, the most powerful of which is the masseter muscle. KT, a current therapeutic approach with various effects on the muscles, is increasingly used in arthrology, oncology, internal medicine, and neurology.
KT exerts its effects entirely through the skin on which it is applied. It lifts the skin and thus increases the interstitial space, which improves blood and lymph circulation [19]. Increased blood circulation and easier transportation of lymphatic fluids reduce inflammation, reduced pressure on nociceptors relieves pain, and a reduction in inflammation and pain increases the range of motion [31]. These changes result in increased physical strength [32]. In addition to these effects, KT provides a continuous sensory stimulus to the tissues, which corrects the joint alignment, improves muscle function, and strengthens the muscles [19].
Muscle function is an important factor in growth and development [33]. Muscles can alter bone shape, volume, and mineralization [33]. According to Moss, changes in functional matrices cause changes in the shape, size, and position of skeletal structures [14]. The regeneration ability of any bone tissue depends primarily on the presence of osteoprogenitor cells in the surrounding tissue and their ability to move to the relevant site and differentiate into osteoblasts [34]. The mechanism of activity of these cells is unclear but may involve several processes, such as the stimulation of angiogenesis, mitochondrial respiration, ATP synthesis, and collagen production [34]. Treatments that increase local blood flow can enhance the transportation of circulating nutrients, cells, oxygen, and inorganic salts to bone tissue [35]. For instance, a study showed that biostimulation through the skin surface increases the blood supply in the bone by 80% and oxygen by 15% [36]. Similarly, some studies reported the stimulation of condylar growth via laser and ultrasound through the skin surface, with or without a functional appliance [17,18]. The present study hypothesized that the increased circulation caused by KT would positively affect cell number and metabolism [37], thus stimulating osteoblastic and chondroblastic activity.
Moreover, KT leads to the controlled lifting of the skin and decreases interstitial resistance, which augments the mobility of muscle fibers [38]. By acting on the muscles, the tape reduces spasms and allows the muscles to undergo maximum contraction and relaxation, thus resulting in increased muscle strength [19]. Studies showed that strengthening the muscles increases the associated bone density and volume [39]. We experimented with KT on the joint area in combination with TB therapy with a view of supporting muscle function, increasing muscle activity and strength, improving circulation, and stimulating cellular activity, and we assessed the resulting change in condylar volume.
Some authors argued that functional appliance therapy should be initiated before the pubertal growth spurt [40], while others have the opinion that it should be started during the pubertal period [41], and some reported that the ideal time for this therapy is during or just after the pubertal growth spurt [42]. Pancherz reported that the increase in sagittal condylar growth was the highest during and just before the pubertal growth spurt [43]. Thus, to maximize treatment effects, we included individuals with a growth stage just before the pubertal growth spurt CS2 and at the peak of the pubertal growth spurt CS3.
Sex is a factor that affects growth, and males and females may respond differently to functional therapy. O’Brien et al. compared the effects of Herbst and TB appliances in individuals with Class II division 1 malocclusions and found that girls responded better to therapy than boys [13]. Hence, this study tried to ensure an equal distribution of boys and girls between the groups (p = 0.837).
Of all tooth-borne functional appliances, the TB is the most commonly used [14]. The major reason why the TB is preferred over other appliances in the clinic can be attributed to the high level of patient acceptance [44]. There is no objective evidence regarding patient adherence, but reports have suggested that patients prefer wearing a TB appliance over other appliances as it is smaller in size and therefore, more aesthetic, and it permits more normal speech patterns [44,45]. In addition to these advantages for the patient, the TB can produce greater skeletal modification than fixed functional appliances [44]. Furthermore, the TB can be used in patients with both short and long lower face heights [45], and it allows the addition of an expansion screw when needed. For these reasons, the TB appliance was used in the present study.
Regarding the activation protocol during functional therapy, some researchers observed no difference between single-step and stepwise activation of the mandible sagittally [46,47], whereas others have noted that, with stepwise activation, each step provides a new stimulus for condylar growth [48]. In this study, we used single-step activation. If needed, further activation was achieved in the patients after this study’s completion.
Achieving a change in the bony structure of the condyle requires 6 months [49]. However, given that no studies have experimented with KT on the face for as long as 6 months, after seeking expert opinion, we conducted our study for 3 months. Moreover, the thickening and proliferation of the condylar cartilage induced by functional stimuli occur in as little as 2 weeks and then disappear [50]. KT produces most of its effects in the early phases of therapy and has no significant effect after a few weeks [37].
Two-dimensional radiographs are widely used for imaging the TMJ for various reasons, including ease of access, practicality, and lower cost [51]. However, these images are adversely affected by various factors, including anatomical superposition, beam projection angle, and patient position, as well as variations in condylar shape and dimensions, which cast doubt on the validity of these modalities [52]. In contrast, three-dimensional modalities provide more accurate measurements in the assessment of the TMJ [53]. In the imaging of joints, CT performs well in revealing bony alterations, whereas magnetic resonance imaging (MRI) is effective at identifying the soft tissues of the disk and internal irregularities [54]. Several studies investigating the morphology of the condyles found CT to be superior to MRI in the assessment of bony changes in the TMJ [55]. Compared with CT, cone-beam computed tomography (CBCT) uses less radiation to acquire images [56]. Based on the ALARA (as low as reasonably achievable) principle, the anatomical structures that constitute the TMJ area yield very good images at exposure levels well below those that achieve the highest image quality [57]. In this study, acquisition parameters were modified based on the ALARA principle, and scans were limited to the clinically examined area to use a radiation dose comparable to that used in CBCT. Studies showed that CT is highly accurate in volumetric measurements [58].
Even with normal mandibular condyle dimensions, there may be differences between the right and left sides, although not statistically significant [59]. Even individuals with no TMJ dysfunction may have a physiological asymmetry of 4–6% in volume between the two sides [59]. Hence, the right and left condylar volumes were assessed separately in this study to eliminate the effect of these differences.
There is no existing protocol for using KT in the joint area for the purposes set in this study. Thus, taping was applied using the “Star Space Correction” technique, based on expert opinion, to overlap with the region targeted in another study [25], aiming to increase condylar volume.
As KT is latex-free, it allows moisture and air to pass through the material. Moreover, the material can be worn for 3–4 days in a row (even in the shower) without compromising its adhesive quality [31]. Thus, based on a previous study [24], the applied tape was scheduled to be replaced every 3 days.
The taping-free group achieved a significant change in both the right condylar volume (p = 0.008, p < 0.05) and left condylar volume (p = 0.019, p < 0.05) consistent with previous studies reporting that TB therapy stimulates condylar growth [60]. However, the lack of a control group in our study to exclude the possible effects of natural growth precluded us from drawing a clear conclusion. Indeed, the condylar cartilage may respond to growth hormones, and growth hormones and biomechanical factors may interact in the TMJ [30]. This could be a confounding factor in the interpretation of our results.
The difference between the taping and non-taping groups in terms of right and left condylar volume changes was not significant (p > 0.05). However, when the effect sizes of Group I and Group II were compared, it was clear that KT relatively increased both the right and left mandibular condyle volumes (Table 2). In our opinion, KT affects the volume of the mandibular condyle relatively but has no effect on the total volume during the active process. This finding is consistent with recent publications that showed no significant increase in muscle activity after taping [61]. This result is also in line with a study by Halski et al., who investigated the effect of KT on the flexibility of the rectus femoris muscle and reported that KT did not significantly alter muscle flexibility [38]. Similarly, Soriano et al. applied KT to the gastrocnemius muscle and found no significant change in its extensibility or strength [62]. Although the effect of KT on tissues has been extensively studied, the biological and cellular mechanisms underlying its efficacy have yet to be elucidated. Some recent studies found the therapeutic efficacy of KT to be insufficient [63], which is in line with our findings.
While the present study focused on the effect of KT on the mandibular condyle in patients receiving functional therapy, quantitative volumetric analyses of other bony components of the craniofacial skeleton or muscle activity should be performed in future studies. Considering the known effects of KT on muscles, further studies are required to investigate its effect on post-therapy relapse in patients using functional appliances. Moreover, based on the proven effect of KT on pain, further studies should assess masseter muscle pain in initial KT sessions used in conjunction with functional appliances. One of the limitations of our study was the sample size. Future studies would benefit from being conducted with larger sample sizes. Additionally, the absence of an untreated control group to validate the current findings and rule out the potential effects of natural growth is another limitation. However, it was deemed unethical to leave individuals with skeletal Class II malocclusion untreated, and thus, a control group was not included for comparison of treatment effects. Moreover, our assessments were short-term, highlighting the need for longer follow-up studies in the future. Although efforts were made to form parallel treatment groups, as Kinesio Taping was not used as an isolated intervention, the direct effects of KT cannot be derived from the present study. Furthermore, additional research is required to investigate the potential clinical effects of Kinesio Taping on overjet reduction, dental trauma injury, and relapse.

5. Conclusions

Within the limits of this study, conclusions can be summarized as follows:
  • Applying Twin Block therapy to patients during the growth period has significantly increased bilateral condylar volumes.
  • Kinesio taping with Twin Block therapy during the three-month period had a positive impact on condylar volume.
  • The application of Kinesio taping in conjunction with Twin Block therapy has slightly increased condylar volumes compared to patients received only Twin Block therapy.
Based on the results of this study, clinicians should consider that the relative and slight increase on condylar volume may provide clinical benefits such as a reduction in the duration of functional appliance use, decreased risk of relapse, and effective correction of overjet.
In light of our research, conducting more studies on compression forces will provide significant contributions to the orthodontic literature.

Author Contributions

Methodology, M.B. and N.O.P.; Investigation, B.B.; Data curation, S.A.; Supervision, B.B. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Institutional Review Board Statement

This study was conducted according to the guidelines of the Declaration of Helsinki and ethical approval was received from the ethics committee of the Karadeniz Technical University Faculty of Medicine (30.12.2021/353).

Informed Consent Statement

Written informed consent has been obtained from the patients to publish this paper and a blank informed consent form was attached.

Data Availability Statement

The data presented in this study are available on request from the corresponding author.

Conflicts of Interest

The authors declare no conflicts of interest, and the sponsors had no role in the design, execution, interpretation, or writing of this study.

References

  1. Graber, T.M. Physiologic Principles of Functional Appliances; Mosby: St. Louis, MO, USA, 1985. [Google Scholar]
  2. Rakosi, T.; Graber, T.; Petrovic, A. Dentofacial Orthopedics with Functional Appliances; Mosby: St. Louis, MO, USA, 1985. [Google Scholar]
  3. Keeling, S.D.; Wheeler, T.T.; King, G.J.; Garvan, C.W.; Cohen, D.A.; Cabassa, S.; McGorray, S.P.; Taylor, M.G. Anteroposterior skeletal and dental changes after early Class II treatment with bionators and headgear. Am. J. Orthod. Dentofac. Orthop. 1998, 113, 40–50. [Google Scholar] [CrossRef] [PubMed]
  4. Tulloch, J.C.; Proffit, W.R.; Phillips, C. Outcomes in a 2-phase randomized clinical trial of early Class II treatment. Am. J. Orthod. Dentofac. Orthop. 2004, 125, 657–667. [Google Scholar] [CrossRef] [PubMed]
  5. Raposo, R.; Peleteiro, B.; Paço, M.; Pinho, T. Orthodontic camouflage versus orthodontic-orthognathic surgical treatment in class II malocclusion: A systematic review and meta-analysis. Int. J. Oral Maxillofac. Surg. 2018, 47, 445–455. [Google Scholar] [CrossRef]
  6. Varlık, S.K.; Gültan, A.; Tümer, N. Comparison of the effects of Twin Block and activator treatment on the soft tissue profile. Eur. J. Orthod. 2008, 30, 128–134. [Google Scholar] [CrossRef]
  7. Clark, W.J. Twin-Block Functional Therapy, 2nd ed.; Mosby: St. Louis, MO, USA, 2002. [Google Scholar]
  8. Batista, K.B.; Thiruvenkatachari, B.; Harrison, J.E.; D O’Brien, K. Orthodontic treatment for prominent upper front teeth (Class II malocclusion) in children and adolescents. Cochrane Database Syst. Rev. 2018, 2018, CD003452. [Google Scholar] [CrossRef]
  9. Magno, M.B.; Nadelman, P.; Leite, K.L.d.F.; Ferreira, D.M.; Pithon, M.M.; Maia, L.C. Associations and risk factors for dental trauma: A systematic review of systematic reviews. Community Dent. Oral Epidemiol. 2020, 48, 447–463. [Google Scholar] [CrossRef]
  10. O’Brien, K.; Wright, J.; Conboy, F.; Chadwick, S.; Connolly, I.; Cook, P.; Birnie, D.; Hammond, M.; Harradine, N.; Lewis, D. Effectiveness of early orthodontic treatment with the Twin-block appliance: A multicenter, randomized, controlled trial. Part 2: Psychosocial effects. Am. J. Orthod. Dentofac. Orthop. 2003, 124, 488–494. [Google Scholar] [CrossRef]
  11. O’brien, K.; Wright, J.; Conboy, F.; Sanjie, Y.; Mandall, N.; Chadwick, S.; Connolly, I.; Cook, P.; Birnie, D.; Hammond, M. Effectiveness of treatment for Class II malocclusion with the Herbst or twin-block appliances: A randomized, controlled trial. Am. J. Orthod. Dentofac. Orthop. 2003, 124, 128–137. [Google Scholar] [CrossRef]
  12. McNamara, J.A., Jr. Functional determinants of craniofacial size and shape. Eur. J. Orthod. 1980, 2, 131–159. [Google Scholar] [CrossRef]
  13. O’Brien, K.; Wright, J.; Conboy, F.; Sanjie, Y.; Mandall, N.; Chadwick, S.; Connolly, I.; Cook, P.; Birnie, D.; Hammond, M. Effectiveness of early orthodontic treatment with the Twin-block appliance: A multicenter, randomized, controlled trial. Part 1: Dental and skeletal effects. Am. J. Orthod. Dentofac. Orthop. 2003, 124, 234–243. [Google Scholar] [CrossRef]
  14. Akan, B.; Ünlü Kurşun, B. Structural changes in the trabecular bone of the mandibular condyle of growing patients with sagittal jaw discrepancy treated with the twin-block appliance. Orthod. Craniofacial Res. 2022, 25, 142–149. [Google Scholar] [CrossRef]
  15. Fushima, K.; Kitamura, Y.; Mita, H.; Sato, S.; Suzuki, Y.; Kim, Y.H.; Department of Orthodontics, Kanagawa Dental College, Yokosuka, Kanagawa, Japan. Significance of the cant of the posterior occlusal plane in Class II division I malocclusions. Eur. J. Orthod. 1996, 18, 27–40. [Google Scholar] [CrossRef]
  16. Koretsi, V.; Zymperdikas, V.F.; Papageorgiou, S.N.; Papadopoulos, M.A. Treatment effects of removable functional appliances in patients with Class II malocclusion: A systematic review and meta-analysis. Eur. J. Orthod. 2015, 37, 418–434. [Google Scholar] [CrossRef]
  17. Oyonarte, R.; Zárate, M.; Rodriguez, F. Low-intensity pulsed ultrasound stimulation of condylar growth in rats. Angle Orthod. 2009, 79, 964–970. [Google Scholar] [CrossRef]
  18. Hameed Mohamed, M.A.; Abdallah, K.F.; Hussein, F.A. Three-dimensional assessment of mandibular condylar volume and position subsequent to twin block functional therapy of skeletal class II malocclusion accompanied by low-level laser therapy. Dent. J. 2020, 8, 115. [Google Scholar] [CrossRef] [PubMed]
  19. Celiker, R.; Guven, Z.; Aydog, T.; Bagis, S.; Atalay, A.; Yagci, H.C.; Korkmaz, N. The kinesiologic taping technique and its applications/Kinezyolojik bantloma teknigi ve uygulama alanlari. Turk. J. Phys. Med. Rehabil. 2011, 57, 225–236. [Google Scholar]
  20. Katsavrias, E. A method for integrating facial cephalometry and corrected lateral tomography of the temporomandibular joint. Dentomaxillofac. Radiol. 2003, 32, 93–96. [Google Scholar] [CrossRef] [PubMed]
  21. Kadesjö, N.; Benchimol, D.; Falahat, B.; Näsström, K.; Shi, X. Evaluation of the effective dose of cone beam CT and multislice CT for temporomandibular joint examinations at optimized exposure levels. Dentomaxillofac. Radiol. 2015, 44, 20150041. [Google Scholar] [CrossRef]
  22. Keskinruzgar, A.; Kucuk, A.O.; Yavuz, G.Y.; Koparal, M.; Caliskan, Z.G.; Utkun, M. Comparison of kinesio taping and occlusal splint in the management of myofascial pain in patients with sleep bruxism. J. Back Musculoskelet. Rehabil. 2019, 32, 1–6. [Google Scholar] [CrossRef] [PubMed]
  23. Ristow, O.; Hohlweg-Majert, B.; Kehl, V.; Koerdt, S.; Hahnefeld, L.; Pautke, C. Does elastic therapeutic tape reduce postoperative swelling, pain, and trismus after open reduction and internal fixation of mandibular fractures? J. Oral Maxillofac. Surg. 2013, 71, 1387–1396. [Google Scholar] [CrossRef]
  24. Bae, Y. Change the myofascial pain and range of motion of the temporomandibular joint following kinesio taping of latent myofascial trigger points in the sternocleidomastoid muscle. J. Phys. Ther. Sci. 2014, 26, 1321–1324. [Google Scholar] [CrossRef]
  25. Kase, K.; Wallis, J.; Kase, T. Clinical Therapeutic Applications of the Kinesio Taping Method, 2nd ed.; Kinesio Taping Association: Tokyo, Japan, 2003. [Google Scholar]
  26. Pautz, N.; Olivier, B.; Steyn, F. The use of parametric effect sizes in single study musculoskeletal physiotherapy research: A practical primer. Phys. Ther. Sport 2018, 32, 87–97. [Google Scholar] [CrossRef] [PubMed]
  27. Cohen, J. The effect size. In Statistical Power Analysis for the Behavioral Sciences; Lawrence Erlbaum Associates: Hillsdale, NJ, USA, 1988; pp. 77–83. [Google Scholar]
  28. Zhang, L.; Luo, J.; Wan, P.; Wu, J.; Laski, F.; Chen, J. Regulation of cofilin phosphorylation and asymmetry in collective cell migration during morphogenesis. Development 2011, 138, 455–464. [Google Scholar] [CrossRef] [PubMed]
  29. Yildirim, E.; Karacay, S.; Erkan, M. Condylar response to functional therapy with Twin-Block as shown by cone-beam computed tomography. Angle Orthod. 2014, 84, 1018–1025. [Google Scholar] [CrossRef] [PubMed]
  30. Petrovic, A.G.; Stutzmann, J.J.; Oudet, C.L. Control processes in the postnatal growth of mandibular cartilage. Rev. Iberoam Ortod. 1986, 6, 11–58. [Google Scholar] [PubMed]
  31. Thelen, M.D.; Dauber, J.A.; Stoneman, P.D. The clinical efficacy of kinesio tape for shoulder pain: A randomized, double-blinded, clinical trial. J. Orthop. Sports Phys. Ther. 2008, 38, 389–395. [Google Scholar] [CrossRef] [PubMed]
  32. Cools, A.; Witvrouw, E.; Danneels, L.; Cambier, D. Does taping influence electromyographic muscle activity in the scapular rotators in healthy shoulders? Man. Ther. 2002, 7, 154–162. [Google Scholar] [CrossRef] [PubMed]
  33. Nordström, P.; Thorsen, K.; Bergström, E.; Lorentzon, R. High bone mass and altered relationships between bone mass, muscle strength, and body constitution in adolescent boys on a high level of physical activity. Bone 1996, 19, 189–195. [Google Scholar] [CrossRef] [PubMed]
  34. Khadra, M.; Kasem, N.; Haanæs, H.R.; Ellingsen, J.E.; Lyngstadaas, S.P. Enhancement of bone formation in rat calvarial bone defects using low-level laser therapy. Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endodontol. 2004, 97, 693–700. [Google Scholar] [CrossRef]
  35. Chen, J.-w.; Zhou, Y.-c. Effect of low level carbon dioxide laser radiation on biochemical metabolism of rabbit mandibular bone callus. Laser Ther. 2004, 14, 0_41–40_44. [Google Scholar] [CrossRef]
  36. Kobu, Y. Effects of infrared radiation on intraosseous blood flow and oxygen tension in the rat tibia. Kobe J. Med. Sci. 1999, 45, 27–39. [Google Scholar] [PubMed]
  37. Shakeri, H.; Keshavarz, R.; Arab, A.M.; Ebrahimi, I. Clinical effectiveness of kinesiological taping on pain and pain-free shoulder range of motion in patients with shoulder impingement syndrome: A randomized, double blinded, placebo-controlled trial. Int. J. Sports Phys. Ther. 2013, 8, 800. [Google Scholar] [PubMed]
  38. Halski, T.; Dymarek, R.; Ptaszkowski, K.; Słupska, L.; Rajfur, K.; Rajfur, J.; Pasternok, M.; Smykla, A.; Taradaj, J. Kinesiology taping does not modify electromyographic activity or muscle flexibility of quadriceps femoris muscle: A randomized, placebo-controlled pilot study in healthy volleyball players. Med. Sci. Monit. Int. Med. J. Exp. Clin. Res. 2015, 21, 2232. [Google Scholar]
  39. Bresin, A. Effects of masticatory muscle function and bite-raising on mandibular morphology in the growing rat. Swed. Dent. J. Suppl. 2001, 150, 1–49. [Google Scholar]
  40. Romagnuolo, L.; Tayal, V.; Tomaszewski, C.; Saunders, T.; Norton, H.J. Optic nerve sheath diameter does not change with patient position. Am. J. Emerg. Med. 2005, 23, 686–688. [Google Scholar] [CrossRef] [PubMed]
  41. Malmgren, O.; Ömblus, J.; Hägg, U.; Pancherz, H. Treatment with an orthopedic appliance system in relation to treatment intensity and growth periods A study of initial effects. Am. J. Orthod. Dentofac. Orthop. 1987, 91, 143–151. [Google Scholar] [CrossRef]
  42. Arat, M.; Isere, H.; Ozdiler, E.; Gürbüs, F. Time factors in functional treatment of skeletal Class II. Informationen Aus Orthod. Und Kieferorthopadie Mit. Beitragen Aus. Der. Int. Lit. 1988, 20, 363–376. [Google Scholar]
  43. Pancherz, H.; Hägg, U. Dentofacial orthopedics in relation to somatic maturation: An analysis of 70 consecutive cases treated with the Herbst appliance. Am. J. Orthod. 1985, 88, 273–287. [Google Scholar] [CrossRef] [PubMed]
  44. Mills, C.M.; McCulloch, K.J. Treatment effects of the twin block appliance: A cephalometric study. Am. J. Orthod. Dentofac. Orthop. 1998, 114, 15–24. [Google Scholar] [CrossRef]
  45. Toth, L.R.; McNamara, J.A., Jr. Treatment effects produced by the Twin-block appliance and the FR-2 appliance of Fränkel compared with an untreated Class II sample. Am. J. Orthod. Dentofac. Orthop. 1999, 116, 597–609. [Google Scholar] [CrossRef] [PubMed]
  46. DeVincenzo, J.P.; Winn, M.W. Orthopedic and orthodontic effects resulting from the use of a functional appliance with different amounts of protrusive activation. Am. J. Orthod. Dentofac. Orthop. 1989, 96, 181–190. [Google Scholar] [CrossRef] [PubMed]
  47. Illing, H.M.; Morris, D.O.; Lee, R.T. A prospective evaluation of Bass, Bionator and Twin Block appliances. Part I-The hard tissues. Eur. J. Orthod. 1998, 20, 501–516. [Google Scholar] [CrossRef]
  48. Bishara, S.E.; Ziaja, R.R. Functional appliances: A review. Am. J. Orthod. Dentofac. Orthop. 1989, 95, 250–258. [Google Scholar] [CrossRef]
  49. Hwang, H.-S.; Jiang, T.; Sun, L.; Lee, K.-M.; Oh, M.-H.; Biao, Y.; Oh, H.-K.; Bechtold, T.E. Condylar head remodeling compensating for condylar head displacement by orthognathic surgery. J. Cranio-Maxillofac. Surg. 2019, 47, 406–413. [Google Scholar] [CrossRef] [PubMed]
  50. Fuentes, M.A.; Opperman, L.A.; Buschang, P.; Bellinger, L.L.; Carlson, D.S.; Hinton, R.J. Lateral functional shift of the mandible: Part I. Effects on condylar cartilage thickness and proliferation. Am. J. Orthod. Dentofac. Orthop. 2003, 123, 153–159. [Google Scholar] [CrossRef] [PubMed]
  51. Ruf, S.; Baltromejus, S.; Pancherz, H. Effective condylar growth and chin position changes in activator treatment: A cephalometric roentgenographic study. Angle Orthod. 2001, 71, 4–11. [Google Scholar]
  52. Hilgers, M.L.; Scarfe, W.C.; Scheetz, J.P.; Farman, A.G. Accuracy of linear temporomandibular joint measurements with cone beam computed tomography and digital cephalometric radiography. Am. J. Orthod. Dentofac. Orthop. 2005, 128, 803–811. [Google Scholar] [CrossRef]
  53. Herrero Solano, Y.; Espinosa Guerra, A.I.; Montoya Pedrón, A.; Soto Cantero, L.A.; Arias Molina, Y. Los bloques gemelos en el tratamiento de las maloclusiones clase III. Revisión. Multimed 2022, 26, 1–17. [Google Scholar]
  54. Katzberg, R.W. Temporomandibular joint imaging. Radiology 1989, 170, 297–307. [Google Scholar] [CrossRef] [PubMed]
  55. Hansson, L.-G.; Westesson, P.-L.; Eriksson, L. Comparison of tomography and midfield magnetic resonance imaging for osseous changes of the temporomandibular joint. Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endodontology 1996, 82, 698–703. [Google Scholar] [CrossRef]
  56. Tsiklakis, K.; Syriopoulos, K.; Stamatakis, H. Radiographic examination of the temporomandibular joint using cone beam computed tomography. Dentomaxillofacial Radiol. 2004, 33, 196–201. [Google Scholar] [CrossRef] [PubMed]
  57. Yu, L.; Liu, X.; Leng, S.; Kofler, J.M.; Ramirez-Giraldo, J.C.; Qu, M.; Christner, J.; Fletcher, J.G.; McCollough, C.H. Radiation dose reduction in computed tomography: Techniques and future perspective. Imaging Med. 2009, 1, 65. [Google Scholar] [CrossRef] [PubMed]
  58. Breiman, R.S.; Beck, J.W.; Korobkin, M.; Glenny, R.; Akwari, O.E.; Heaston, D.K.; Moore, A.V.; Ram, P.C. Volume determinations using computed tomography. Am. J. Roentgenol. 1982, 138, 329–333. [Google Scholar] [CrossRef]
  59. Tecco, S.; Saccucci, M.; Nucera, R.; Polimeni, A.; Pagnoni, M.; Cordasco, G.; Festa, F.; Iannetti, G. Condylar volume and surface in Caucasian young adult subjects. BMC Med. Imaging 2010, 10, 28. [Google Scholar] [CrossRef] [PubMed]
  60. McNamara, J.A., Jr.; Carlson, D.S. Quantitative analysis of temporomandibular joint adaptations to protrusive function. Am. J. Orthod. 1979, 76, 593–611. [Google Scholar] [CrossRef] [PubMed]
  61. Alexander, C.; Stynes, S.; Thomas, A.; Lewis, J.; Harrison, P. Does tape facilitate or inhibit the lower fibres of trapezius? Man. Ther. 2003, 8, 37–41. [Google Scholar] [CrossRef] [PubMed]
  62. Gómez-Soriano, J.; Abián-Vicén, J.; Aparicio-García, C.; Ruiz-Lázaro, P.; Simón-Martínez, C.; Bravo-Esteban, E.; Fernández-Rodríguez, J.M. The effects of Kinesio taping on muscle tone in healthy subjects: A double-blind, placebo-controlled crossover trial. Man. Ther. 2014, 19, 131–136. [Google Scholar] [CrossRef] [PubMed]
  63. Bicici, S.; Karatas, N.; Baltaci, G. Effect of athletic taping and kinesiotaping® on measurements of functional performance in basketball players with chronic inversion ankle sprains. Int. J. Sports Phys. Ther. 2012, 7, 154. [Google Scholar]
Applsci 14 08845 g001
Figure 1. Flowchart of patients in study.
Figure 1. Flowchart of patients in study.
Applsci 14 08845 g001
Applsci 14 08845 g002
Figure 2. Twin Block appliance.
Figure 2. Twin Block appliance.
Applsci 14 08845 g002
Applsci 14 08845 g003
Figure 3. Application of KT with TB therapy using the Star Space Correction technique.
Figure 3. Application of KT with TB therapy using the Star Space Correction technique.
Applsci 14 08845 g003
Applsci 14 08845 g004
Figure 4. Three-dimensional image created to include only bone structures and isolation of the mandibular condyle for volumetric measurement: (a) an initial cut intersecting the orbitale and porion points, (b,c) following cuts parallel to the first line at the top of the condyle and the bottom of the sigmoid notch, and (d) a lateral view of the final isolated condyle.
Figure 4. Three-dimensional image created to include only bone structures and isolation of the mandibular condyle for volumetric measurement: (a) an initial cut intersecting the orbitale and porion points, (b,c) following cuts parallel to the first line at the top of the condyle and the bottom of the sigmoid notch, and (d) a lateral view of the final isolated condyle.
Applsci 14 08845 g004
Applsci 14 08845 g005
Figure 5. The formula for effect size calculation.
Figure 5. The formula for effect size calculation.
Applsci 14 08845 g005
Applsci 14 08845 g006
Figure 6. Distribution of right side initial and final condyle volumes (cm3).
Figure 6. Distribution of right side initial and final condyle volumes (cm3).
Applsci 14 08845 g006
Applsci 14 08845 g007
Figure 7. Distribution of left side initial and final condyle volumes (cm3).
Figure 7. Distribution of left side initial and final condyle volumes (cm3).
Applsci 14 08845 g007
Table 1. Comparison of patient characteristics by group.
Table 1. Comparison of patient characteristics by group.
Groupp
Group I (n = 15)Group II (n = 14)
Gender, n (%)Female8 (53.3)8 (57.1)a 0.837
Male7 (46.7)6 (42.9)
Age (years)Mean ± Sd12.78 ± 0.9712.82 ± 1.21b 0.813
Median (Min–Max)12.75 (11–15)12.66 (10–15)
a Pearson Chi-square; b Mann–Whitney U-test.
Table 2. Comparison of right condyle volume by group.
Table 2. Comparison of right condyle volume by group.
Right Condyle Volume (cm3)Group I (n = 15)Group II (n = 14)%95 CIp
Initial Condyle VolumeMean ± Sd1.85 ± 0.301.77 ± 0.38[−0.18: 0.34]a 0.591
Median (min–max)1.8 (1.4–2.3)1.8 (1.1–2.6)
Final Condyle VolumeMean ± Sd1.98 ± 0.281.93 ± 0.37[−0.21: 0.29]a 0.591
Median (min–max)2.1 (1.4–2.3)2 (1.4–2.6)
Difference ∆pb 0.015 *b 0.008 **
Initial–finalMean ± Sd0.13 ± 0.170.16 ± 0.17[−0.16: 0.09]a 0.331
Effect sizeCohen’s D0.6520.426
%95 CI[0.04: 0.22][0.06: 0.26]
a Mann–Whitney U-test; b Wilcoxon signed-rank test; ** p < 0.01; * p < 0.05.
Table 3. Comparison of left condyle volume by group.
Table 3. Comparison of left condyle volume by group.
Left Condyle Volume (cm3)Group I (n = 15)Group II (n = 14)%95 CIp
Initial Condyle VolumeMean ± Sd1.63 ± 0.291.78 ± 0.58[−0.49: 0.19]a 0.621
Median (min–max)1.7 (1.2–2.1)1.7 (1–3)
Final Condyle VolumeMean ± Sd1.93 ± 0.281.89 ± 0.40[−0.22: 0.30]a 0.652
Median (min–max)1.9 (1.4–2.4)1.8 (1.4–2.8)
Difference ∆pb 0.001 **b 0.019 *
Initial–finalMean ± Sd0.30 ± 0.210.11 ± 0.38[−0.04: 0.42]a 0.158
Effect sizeCohen’s D1.052 0.220
%95 CI[0.18: 0.42][0.11: 0.33]
a Mann–Whitney U-test; b Wilcoxon signed-rank test; ** p < 0.01; * p < 0.05.
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content.

Share and Cite

MDPI and ACS Style

Bolukbasi, M.; Baser, B.; Akkaya, S.; Ozunlu Pekyavas, N. Three-Dimensional Assessment of the Effects of Kinesio Taping on Mandibular Condylar Volume with Skeletal Class II Malocclusions. Appl. Sci. 2024, 14, 8845. https://doi.org/10.3390/app14198845

AMA Style

Bolukbasi M, Baser B, Akkaya S, Ozunlu Pekyavas N. Three-Dimensional Assessment of the Effects of Kinesio Taping on Mandibular Condylar Volume with Skeletal Class II Malocclusions. Applied Sciences. 2024; 14(19):8845. https://doi.org/10.3390/app14198845

Chicago/Turabian Style

Bolukbasi, Merve, Baris Baser, Selcuk Akkaya, and Nihan Ozunlu Pekyavas. 2024. "Three-Dimensional Assessment of the Effects of Kinesio Taping on Mandibular Condylar Volume with Skeletal Class II Malocclusions" Applied Sciences 14, no. 19: 8845. https://doi.org/10.3390/app14198845

APA Style

Bolukbasi, M., Baser, B., Akkaya, S., & Ozunlu Pekyavas, N. (2024). Three-Dimensional Assessment of the Effects of Kinesio Taping on Mandibular Condylar Volume with Skeletal Class II Malocclusions. Applied Sciences, 14(19), 8845. https://doi.org/10.3390/app14198845

Note that from the first issue of 2016, this journal uses article numbers instead of page numbers. See further details here.

Article Metrics

Back to TopTop