Comparison of treatments with the Forsus fatigue resistant device in relation to skeletal maturity: a cephalometric and magnetic resonance imaging study

Evaluating the Effects of Carriere Motion Appliance and Twin Block Appliances in Class II Correction-A Retrospective Study

This retrospective study compared Class II orthodontic non-extraction treatment using Carriere Motion Appliance (CMA) and Twin Block (TB) appliances.

METHODS

The treatment of 38 patients was assessed. Pre- and post-treatment cephalometric radiographs were analyzed to evaluate skeletal, dental, and soft tissue treatment outcomes and efficacy.

RESULTS

Both appliances effectively corrected the Class II molar relationship. When measured at the distal aspect of the first molar, TB achieved 4.22 mm, while CMA had a 2.55 mm correction. When measured in the mesial aspect, the CMA achieved a 3.9 mm correction. The changes in SNB and ANB were statistically significant only in the TB group. The CMA appliance demonstrated statistically significantly less protrusion of the mandibular incisors and less upper incisor retrusion without vertical changes compared to the TB appliance. The TB demonstrated statistically significant lower lip protrusion compared to the CMA.

CONCLUSION

The CMA corrects Class II malocclusions only by exerting a dentoalveolar influence and does not demonstrate the added effects associated with TB, such as elongation of lower facial height (LFH) and less loss of lower anchorage. Nonetheless, the correction in the TB group comprised both dentoalveolar and skeletal components. The CMA promotes a multidirectional upper and lower molar movement, and despite our 2D cephalometric analysis, we were able to estimate the extent of upper molar derotation.

Effects of the Forsus fatigue-resistant device and mandibular anterior repositioning appliance in Class II malocclusion treatment

INTRODUCTION

Fixed functional appliances have been used to treat Class II malocclusion by a huge number of professionals. This retrospective study aimed to analyze the effects of the Forsus fatigue-resistant device and compare the findings with a well-matched group treated with the mandibular anterior repositioning appliance (MARA).

METHODS

The Forsus group was composed of 14 patients at an initial mean age of 12.4 ± 1.3 years, treated with the Forsus fatigue-resistant device followed by a fixed orthodontic appliance. The MARA group comprised 18 patients at an initial mean age of 12.1 ± 1.3 years, treated with MARA followed by fixed orthodontic appliances. The untreated control group consisted of 14 patients matched with the other groups. Posttreatment changes were calculated as T1 - T2. Intergroup comparisons regarding treatment changes were performed using repeated-measures analysis of variance followed by Tukey's test.

RESULTS

During treatment, the Forsus group showed a statistically significant decrease in maxillary protrusion and maxillomandibular sagittal discrepancy in the control group. The MARA group showed significantly greater retrusion of maxillary incisors than the Forsus and the control group. Overjet decreased significantly more in the treated groups in relation to the control group. Molar relationship improved significantly more in both treated groups, and both showed more correction than the untreated control group.

CONCLUSIONS

The Forsus and MARA associated with fixed appliances effectively corrected the Class II malocclusion, mostly using dentoalveolar changes and maxillary growth restriction.

Attractiveness of the facial profile: comparison of Class II patients treated with Twin Force® or intermaxillary elastics

Objective:

To compare the facial profile attractiveness of Class II patients treated with Twin Force^® or intermaxillary elastics.

Methods:

Sample comprised 47 Class II patients divided into two groups: G1) TWIN FORCE - 25 patients treated with fixed appliances and Twin Force^® fixed functional appliance (mean initial age was 17.91 ± 7.13 years, mean final age was 20.45 ± 7.18 years, and mean treatment time was 2.53 ± 0.83 years); G2) ELASTICS - 22 patients treated with fixed appliances and Class II intermaxillary elastics (mean initial age was 15.87 ± 5.64 years, mean final age was 18.63 ± 5.79 years and mean treatment time was 2.75 ± 0.60 years). Lateral cephalograms from pretreatment and posttreatment were used. Cephalometric variables were measured and silhouettes of facial profile were constructed and evaluated by 48 laypeople and 63 orthodontists, rating the attractiveness from 0 (most unattractive profile) to 10 (most attractive profile). Intergroup comparisons were performed with Mann-Whitney and independent t-tests.

Results:

At pretreatment, facial profile of the Twin Force^® group was less attractive than the Elastics group. Treatment with Twin Force^® or Class II elastics resulted in similar facial profile attractiveness, but the facial convexity was more reduced in the Twin Force^® group. Orthodontists were more critical than laypeople.

Conclusions:

Treatment with Twin Force^® or Class II elastics produced similar facial profile attractiveness at posttreatment. Profile attractiveness was reduced with treatment in the elastic group, and improved in the Twin Force^® group. Facial convexity was more reduced with treatment in the Twin Force^® group.

A Cephalometric Evaluation and Comparison of Skeletal, Dentoalveolar, and Soft Tissue Changes Brought about by the Forsus Fatigue Resistant Device and PowerScope Fixed Functional Appliance

Background:

Though studies have been conducted on the PowerScope, not many researches are available in the literature which compare its effects with other fixed functional appliances. Therefore, the aim of our study was cephalometric evaluation and comparison of the skeletal, dentoalveolar, and soft tissue changes brought about by the Forsus Fatigue Resistant Device and PowerScope appliance.

Materials and Methods:

Pre and Posttreatment cephalometric records of 20 patients with Class II Division 1 malocclusion treated with fixed functional appliances (Forsus Fatigue Resistant Device and PowerScope) were compared. Values of various cephalometric parameters were used to evaluate the skeletal, dental, and soft tissue changes. Wilcoxon signed-rank test (intragroup comparison) and Mann–Whitney U test (intergroup) were used to see significant differences in the parameters ( P ≤ .05).

Results:

Both the appliances were successful in correcting the Class II discrepancy. Skeletal changes were seen significantly in both the groups, though they were more in the Forsus patients. Dentoalveolar changes were predominantly seen in PowerScope patients. Also, an improvement in soft tissue profile was seen in both the groups.

Conclusion:

From our study, we concluded that the PowerScope and the Forsus Fatigue Resistant Device are equally good options for the correction of skeletal Class II malocclusion due to a retrognathic mandible, as they achieve changes in all the three aspects: skeletal, dentoalveolar and soft tissue.

Skeletal and dentoalveolar contributions during Class II correction with Forsus™ FRD appliances : Quantitative evaluation

PURPOSE

Primary objective of the study is to quantify and evaluate the skeletal and dental contributions during sagittal Class II correction with the Forsus™ fatigue resistant device (FRD; 3M Unitek Corp., Monrovia, CA, USA). Secondary objective is to evaluate the overall vertical, soft tissue and chin-throat relation changes with the Forsus™ appliance.

PATIENTS AND METHODS

A retrospective sample of 27 Class II patients treated with the Forsus™ FRD appliance was compared to 20 untreated control subjects who were matched according to age and craniofacial morphology. Pre-Forsus™ (T0) and Post-Forsus™ (T1) cephalograms were subjected to composite cephalometric analysis. Growth changes were subtracted from the treatment changes to obtain the treatment effects of the appliance. The data were analyzed using Student's t‑test and independent t test.

RESULTS

Significant differences were found between the treated and the control group in 16 of 29 measured variables. The overjet and molar relation improved by 4.23 mm and 4.49 mm, respectively. This was mainly achieved by backward movement of maxillary incisors (1.4 mm) and molars (1.22 mm) and forward movement of mandibular incisors (2.26 mm) and molars (2.70 mm). Overbite decreased by 2.24 mm with no changes in mandibular and nasal plane angles.

CONCLUSION

The Forsus™ FRD was effective in correcting Class II malocclusion mainly at the dentoalveolar level. The net skeletal and dentoalveolar contributions towards both overjet and molar correction was 13% and 87%, respectively. The improvement in soft tissue profile and chin-throat configuration was statistically insignificant.

Pharyngeal airway, hyoid bone, and soft palate changes after Class II treatment with Twin-block and Forsus appliances during the postpeak growth period

INTRODUCTION

This study aimed to compare cephalometrically the pharyngeal airway, hyoid bone, and soft palate (SP) changes after Class II malocclusion treatments using Twin-block (TWB) and Forsus Fatigue Resistant Device (FFRD) (3M Unitek Corp, 3M Dental Products, Monrovia, Calif) during the postpeak growth period.

METHODS

Forty-two patients with Class II malocclusion treated during the postpeak growth period were randomly and retrospectively included in this study. These patients were divided into 2 treatment groups: TWB and FFRD. The skeletal, dental, pharyngeal airway, hyoid bone position, and SP measurements were obtained from the lateral cephalometric radiographs taken at the beginning and at the end of the treatment. Paired-samples and independent-samples t tests were used for the intragroup and intergroup comparisons, respectively.

RESULTS

In the TWB group, the SNB (°), Md1-NB (mm), Md1-NB (°), and McNamara upper and lower pharyngeal airway dimensions significantly increased, whereas the ANB (°), AD1-Ba (mm), AD2-H (mm), adenoidal nasopharyngeal area, and SP angle decreased (P < 0.05). In the FFRD group, the SNB (°), Md1-NB (mm), Md1-NB (°), Ptm-Ba (mm), and McNamara upper airway dimensions significantly increased, whereas the ANB (°), AD2-H (mm), and interincisor angle decreased (P < 0.05). Moreover, there were statistically significant differences in the Md1-NB angles and SP thicknesses between the 2 groups (P < 0.05).

CONCLUSIONS

The effects of TWB and FFRD treatment on the airway during the postpeak growth period were similar. However, the FFRD caused a greater mandibular incisor protrusion.

Evaluation of the splint-supported Forsus Fatigue Resistant Device in skeletal Class II growing subjects

OBJECTIVES

To evaluate the use of the Forsus Fatigue Resistant Device (FFRD), supported with bimaxillary splints, in treatment of skeletal Class II malocclusion.

MATERIALS AND METHODS

Data from 46 skeletal Class II females who received either conventional Forsus alone (FFRD group) (15 patients, 12.54 ± 0.90 years), FFRD and bimaxillary splints (splint-FFRD group) (15 patients, 12.29 ± 0.82 years), or were untreated controls (16 subjects, 12.1 ± 0.9 years) were retrieved from previous clinical trials. FFRD was inserted onto the mandibular archwire in the FFRD group after leveling and alignment with multibracket appliances. In the splint-FFRD group, Forsus was inserted between fixed maxillary and mandibular splints. Treatment continued until reaching an edge-to-edge incisor relationship.

RESULTS

Both treatment groups failed to induce significant mandibular skeletal effects compared to the normal growth exhibited by untreated controls. The splint-FFRD group showed significant reduction of SNA (-0.88° ± 0.51°) and ANB (-1.36° ± 0.87°). The mandibular incisors showed significant proclination in the FFRD (9.17° ± 2.42°) and splint-FFRD groups (7.06° ± 3.34°).

CONCLUSIONS

The newly proposed splint-supported FFRD was equally effective as the conventional FFRD in treatment of Class II malocclusion with dento-alveolar changes and additional maxillary restricting effect. It has an additional advantage of immediate initiation of the Class II correction.

Complications encountered during Forsus Fatigue Resistant Device therapy

Introduction:

Fixed functional appliances are non-compliant solutions to Class II malocclusion treatment. The clinician, however, should be careful of unexpected complications during the therapy.

Methods:

58 female adolescents who presented with Class II malocclusion due to deficient mandible were treated with Forsus Fatigue Resistant Device (FFRD) therapy until an overcorrection to an edge to edge incisor relationship was achieved.

Results:

Incisor relationship and overjet were corrected successfully in all the subjects. Twenty-two patients had a complications-free treatment, while several complications were encountered with the remaining 36 subjects. In particular, mandibular canine rotation and development of posterior crossbites were the most common complications, with percentages of 51.7% and 25.9% respectively. Other complications included the breakage and shearing of the extraoral tubes of the first molar bands, and excessive intrusion of the upper first molars.

Conclusions:

FFRD is an efficient appliance for treatment of Class II malocclusion; however, different complications were encountered during the appliance therapy. A focus on taking precautions and applying preventive measures can help to avoid such problems, reducing the number of emergency appointments and enhancing the treatment experience with the appliance.

Long-term effects of the Forsus Device in Class II division I patients treated at pre-peak, peak, and post-peak growth periods: A retrospective study

OBJECTIVES

To assess the long-term effects of the Forsus Fatigue Resistant Device (FFRD) for the correction of Class II division 1 malocclusion during pre-peak, peak, and post-peak growth periods.

MATERIALS AND METHODS

This retrospective study was conducted on 60 patients that received FFRD with concurrent full-fixed orthodontic appliances during pre-peak (n=18), peak (n=21) and post-peak (n=21) maturational stages. The FFRD groups were compared with 60 untreated Class II control subjects obtained from the University of Michigan growth study and matched by skeletal age, sex, and observation periods. Lateral cephalograms were obtained at three time-points: [T1] pre-treatment; [T2] end of comprehensive orthodontic treatment; and [T3] retention (average of 3 years in retention). Nineteen linear and angular measurements were recorded. Short-term (T1- T2) and long-term (T1-T3) treatment changes were analyzed using paired Wilcoxon Signed Rank tests.

RESULTS

In the pre-peak group, FFRD caused temporary restraint of maxillary growth and an increase in mandibular length at T1-T2 compared to controls. No significant differences were found at T2-T3 time points. The net changes (T1-T3) included a restraining effect on the maxilla and dentoalveolar compensation. In the peak group, maxillary restraint effect was seen at T1-T2, but this effect relapsed at T2-T3 time points. Similar to the pre-peak group, the net results (T1-T3) included maxillary headgear effect and dentoalveolar compensation. In the post-peak group, the net effects (T1-T3) of treatment included only dentoalveolar compensation.

CONCLUSIONS

Overall, Class II malocclusion correction with FFRD is stable at three years post-treatment and is mainly achieved by maxillary restraint and dentoalveolar compensation at the pre-peak and peak stages and dentoalveolar compensation during the post-peak stage.

Treatment outcome and long-term stability of class II correction with forsus fatigue resistant device in non-growing patients

OBJECTIVES

Forsus™ Fatigue Resistant Device (FRD) is one of the commonly used semirigid fixed functional devices. Purpose of the present study was to investigate effects and long-term stability of Class II correction following use of Forsus FRD in a retrospective clinical study.

SETTING AND SAMPLE POPULATION

Records of 20 patients (mean age 18.3 ± 2.5 years) with Class II malocclusion, who had undergone fixed functional treatment protocol with Forsus FRD, were collected from our clinical archive.

MATERIALS AND METHODS

Lateral cephalometric radiographs at pre-treatment (T0), end of comprehensive treatment (T1) and post-retention period (T2, mean duration: 19 ± 3 months) were analysed and superimposed to assess skeletal and dental changes on the long-term. Repeated measurement one way ANOVA was used for the study of the significant differences among the mean values of cephalometric parameters at T0, T1, and T2. To analyse the nature of the bilateral significant differences between two different time points, Bonferroni test was used.

RESULTS

Sagittal and vertical skeletal changes at T0-T1 were statistically insignificant while all dentoalveolar parameters exhibited highly significant changes. At T1-T2, all skeletal and dentoalveolar parameters were stable except the slight relapse in overjet (0.3 ± 0.5 mm; P < .05). At T0-T2 interval, no significant skeletal changes were recorded while the dentoalveolar changes remained significantly improved.

CONCLUSION

Correction of Class II malocclusion achieved with Forsus FRD was dentoalveolar and treatment effects were stable in the 19 ± 3 months follow-up period.

Treatment efficiency of activator and skeletal anchored Forsus Fatigue Resistant Device appliances

OBJECTIVES

The aim of the study was to investigate the treatment efficiency of miniplate anchored Forsus Fatigue Resistant Device (MAF) as compared with the activator appliance.

MATERIALS AND METHODS

Mandibular retrognathia was treated with two methods, the MAF group (8 girls, 11 boys, mean age 13.03 ± 0.69 years) and the activator group (7 girls, 12 boys, mean age 12.68 ± 0.73 years). An untreated control group (9 girls, 10 boys, mean age 12.95 ± 0.73 years) was constructed to eliminate growth-related changes through the American Association of Orthodontists Foundation Legacy Collection. Data of 114 lateral cephalograms were analyzed.

RESULTS

The inhibition of the maxillary growth was greater in the MAF group, whereas forward displacement of the mandible was higher in the activator group (P < 0.05). Sagittal maxillomandibular relation was improved similarly in both treatment groups (P < 0.05). Mandibular length was increased in both treatment groups with the highest increase in the activator group (P < 0.05). Retroclination of the incisors was observed in the MAF group (P < 0.05). The upper lip was retruded in the MAF group and lower lip was protruded in the activator group (P < 0.05).

CONCLUSION

The activator created greater mandibular changes, whereas the MAF provides somewhat smaller mandibular changes due to the restriction caused by retroclined maxillary incisors.

CLINICAL RELEVANCE

Although both MAF and activator treatments caused favorable maxillomandibular changes, new treatment alternatives that reduce dentoalveolar side effects and eliminate patient cooperation are still required to achieve skeletal correction in class II malocclusion treatment in growing patients.

Therapeutic effectiveness of AdvanSync2 at different stages of skeletal maturity in skeletal Class II malocclusion: A single-blind clinical trial

Objectives:

AdvanSync2 (Ormco, Glendora, California, USA) is a molar-to-molar fixed Class II corrector, based on the philosophy of Herbst which allows the bonding of the both upper and lower arches simultaneously along with fixed functional therapy. The purpose of this study was to cephalometrically compare the skeletal and dentoalveolar effects of AdvanSync2 in the correction of Class II malocclusions in circumpubertal and post-pubertal patients.

Materials and Methods:

Forty-eight samples were selected and divided into two groups based on their CVMI staging, Group A, i.e., at CVMI Stages 2 and 3 (18 girls and six boys) and Group B, i.e., CVMI Stages 4, 5, and 6 (19 girls and five boys). Cephalograms taken at pre- and post-AdvanSync2 stages were compared and analyzed.

Results:

The results showed that there was a significant increase in mandibular length in both groups. Both the groups also showed sagittal maxillary restriction, maxillary molar distalization, and retroclination of maxillary incisors. On comparison between Group A and Group B, there was no statistically significant differences in terms of maxillary position, size of maxilla, as well as upper and lower incisor inclinations in Group A except for improvement of mandibular position (SNB; P ≤ 0.01) and greater amount of chin growth (B -Pg; P ≤ 0.01) with respect to Group B.

Conclusion:

AdvanSync2 can be used as an effective fixed functional appliance in post-pubertal group for sagittal mandibular correction in skeletal Class II patients.

Management of skeletal class II malocclusion using bimaxillary skeletal anchorage supported fixed functional appliances : A novel technique

AIM

To evaluate the treatment effects in growing skeletal class II patients subjected to a novel treatment technique, i.e., bimaxillary miniplates supported fixed functional appliance. The null hypothesis was that there is no statistically significant difference in skeletal changes of patients with class II malocclusion treated with bimaxillary skeletal anchorage supported fixed functional appliance and those who were not provided any intervention.

METHODS

The sample comprised 32 skeletal class II subjects (17 males and 15 females) with a Cervical Vertebrae Maturity Index (CVMI) demonstrating peak of pubertal growth spurt. Sixteen patients (12.37 ±1.09 years of age) were treated with bimaxillary skeletal anchorage supported fixed function appliance, while 16 well-matched subjects (12.06 ± 1.34 years of age) were included as controls. For both groups, cephalograms (T1, T2) were taken with a matched observational interval of about 7.5 months; 17 linear and 10 angular measurements were recorded. The intraclass correlation coefficient (ICC) was used to determine reliability of measurements recorded. Student t test was carried out to determine the changes produced by the treatment relative to control.

RESULTS

When compared with the control group, the treatment group demonstrated significant maxillary retrusion. No significant changes were seen in mandibular growth pattern, whereas mandibular length increased significantly more than in the control group (B-VP: 3.05 mm; Co-Gn: 2.65 mm). Treatment mechanics had minimal effects on maxillary dentition. Mandibular incisors proclined by an average of 3.06°. Maxilla-mandibular relation improved significantly (ANB: -4.29°; NA-Pog: -3.76°).

CONCLUSION

The new bimaxillary skeletal anchorage supported fixed functional appliance technique was found to be highly effective in the treatment of class II malocclusion with significant skeletal changes.

Comparison of 2 treatment protocols using fixed functional appliances in Class II malocclusion: Treatment results and stability

INTRODUCTION

The objective of this research was to compare the 2 treatment protocols including a functional mandibular advancer (FMA; Forestadent, Pforzheim, Germany) followed by multibracket appliances (MBAs) vs a Forsus device (3M Unitek, Monrovia, Calif) in combination with MBA concerning treatment outcomes and posttreatment stability.

METHODS

This study was conducted using lateral cephalograms of patients who were treated with MBA, which was used either after an FMA or concurrently with a Forsus device, and of patients who had untreated Class II malocclusion (control group). Each group consisted of 19 subjects in cervical stage 2 or cervical stage 3 stages according to the cervical vertebral maturation index. Cephalograms were taken for the treated groups at T1 (pretreatment), T2 (completion of the MBA treatment), and T3 (at least 2 years after T2).

RESULTS

Significant intergroup differences at the T1-T2 period were observed in favor of the FMA concerning mandibular advancement, intermaxillary relationship, and mandibular elongation. With Forsus treatment, restrained maxillary growth and a slightly improved intermaxillary relationship rebounded after treatment (P <0.05). At the end of treatment, mandibular incisor protrusion and occlusal plane rotation were greater in the Forsus group than in the FMA group (P <0.05), and maxillary incisor retroclination was significant in the Forsus group. During the posttreatment period, although no significant changes were present in the incisors' inclination, relapses of the T1-T2 improvements in overjet and overbite and the recidive of the occlusal plane rotation were significantly higher in the Forsus group.

CONCLUSIONS

Treatment protocol including an FMA was found to be more effective with mandibular skeletal effects and was more stable with a lesser degree of relapse in overjet and overbite than the Forsus protocol.

Anterior open bite due to idiopathic condylar resorption during orthodontic retention of a Class II Division 1 malocclusion

A common dilemma when treating anterior open bite is understanding its etiology. Idiopathic condylar resorption (ICR) can cause open bite in affected individuals. Although it is prudent to not treat patients with ICR until active resorption has ceased, orthodontists may begin treating them because anterior open bite from ICR may not appear before or during their orthodontic treatment. This article reports a 12-year-old female who was diagnosed with ICR 10 months after completion of her orthodontic treatment for a Class II Division 1 malocclusion. When a young patient with a high mandibular angle and previous skeletal or dental Class II malocclusion returns with an open bite during the retention phase, the patient's condyles must be carefully examined to determine whether any temporomandibular joint disorder, such as ICR, is present. Currently, the controversy over the cause and the cure for ICR is continuing to challenge orthodontists in diagnoses and treatments. Orthodontists should closely monitor and offer informed treatment options to patients with risk factors for ICR or signs of its pathology that might develop at any stage of orthodontic treatment, including the retention period.

Evaluating the treatment effectiveness and efficiency of Carriere Distalizer: a cephalometric and study model comparison of Class II appliances

Background

The purpose of this study was to evaluate the treatment effectiveness of Carriere Distalizer in comparison to Class II intermaxillary elastics and Forsus.

Methods

Three groups of patients treated with Class II intermaxillary elastics (n = 18), Carriere Distalizer (n = 18), and Forsus appliance (n = 18) were collected from three private orthodontic practices. Inclusion criteria were as follows: (1) 10–14 years old of start age with permanent dentition, (2) no history of previous orthodontic treatment, (3) complete pre- and post-treatment records, (4) dental Class II division 1 (end-to-end or more), (5) no pre-treatment transverse discrepancy, (6) non-extraction treatment plan, and (7) Class I post-treatment occlusal relationship. The data consisted of cephalometric and study model measurements from pre- and post-treatment records and treatment time. Two-tail Student t test was used to analyze the differences in cephalometric changes and dental corrections between Carriere Distalizer group and Class II elastics/Forsus group.

Results

All three groups of patients showed no differences in the age of treatment initiation, pre-treatment cephalometric measurements and discrepancy index (DI). The time of Class II correction for Carriere Distalizer was significantly shorter than that for Class II elastics; there was no difference in the length of Class II correction between Carriere Distalizer and Forsus groups. The amount of Class II correction (canine/molar relationship) was significantly lower for Carriere Distalizer when compared with Forsus appliance. Carriere Distalizer, similarly to Class II elastics, did not induce any statistically significant correction in skeletal component (ANB and Wits appraisal).

Conclusions

There is no clinically significant skeletal correction induced by Carriere Distalizer in growing patients. Carriere Distalizer can be applied to treatment of mild to moderate Class II dental malocclusion over 6 months on average, although the total treatment time may be prolonged due to various side effects. Overall, the Carriere Distalizer appears to be no more effective or efficient than alternatives in the treatment of Class II malocclusion.

Evaluation of Sagittal Changes in Class II Div 2 Patients with Decelerating Phase of Growth by PowerScope Appliance: A Retrospective Cephalometric Investigation

BACKGROUND

Restricted mandibular growth is observed in Class II Div 2 malocclusions. The fixed functional appliances are used to effect the skeletal changes in patients with end stages of skeletal maturity.

AIM

This cephalometric study aimed to distinguish the skeletal and dental corrections done in the mandible on skeletal Class II Div 2 subjects when treated with PowerScope appliance (American Orthodontics, Sheboygan, WI).

MATERIALS AND METHODS

This is a cephalometric study based on the retrospective data. The patients selected for this study were with Class II Div 2 malocclusion and assessed to be in decelerating phase of skeletal growth. A total of 12 patients were selected after applying inclusion and exclusion criteria. A PowerScope was placed after incisor correction and followed up till Class I molar relation was achieved. The initial values (T1) at the time of placement of the appliance and the final values at the end of the molar correction (T2) were noted. The cephalometric parameters at T1 and T2 were assessed using sagittal occlusal (SO) analysis by Pancherz. The paired Student's t-test was used to analyze pre- and posttreatment changes.

RESULTS

There was sufficient lengthening of the mandible (4.38 mm). Both the dental and skeletal alterations were observed in the mandible. These changes were marked compared to the maxilla. The pre- and posttreatment changes were statistically significant for the mandibular skeletal changes (P < 0.001) as well as mandibular incisor proclination (P < 0.001).

CONCLUSION

The PowerScope can be used as a propeller for sagittal mandibular correction in Class II Div 2 patients.

Dentoskeletal effects of the forsus™ fatigue resistance device in the treatment of class II malocclusion: A systematic review and meta-analysis

OBJECTIVE:

The aim of this systematic review and meta-analysis is to quantitatively compare previous studies that evaluated skeletal and dentoalveolar effects of the Forsus™ Fatigue Resistance Device (FRD) in the treatment of Class II malocclusion with a matched untreated control group.

MATERIALS AND METHODS:

Four electronic searches PubMed, Web of Science, Cochrane Library, and Science Direct that were limited to articles on human studies comparing the effect of Forsus appliance with a matched control group in the treatment of Class II malocclusion from the year (2000–2017). An additional manual search was carried out by examining the references of the included articles, SEARCH terms included; Forsus and Class II malocclusion. The quality of the included studies was assessed using the modified methodological score for clinical trials. The data were analyzed using Michael Borenstein's Comprehensive Meta-Analysis Software (V3.3.070, Biostat, Inc., US).

RESULTS:

Seven studies were included comprising 273 participants (Forsus group = 142; control group = 131). The results indicated a statistical significant skeletal effect of the Forsus appliance on increasing the occlusal plane only (P < 0.001). The results also indicated a statistical significant (P < 0.001) dentoalveolar effects of the Forsus appliance on the following outcomes; protruding, proclining, and intruding lower incisors; retroclining upper incisors, distalizing and intruding upper molars, as well as reducing overjet and overbite.

CONCLUSIONS:

The Forsus™ showed positive effects on the maxillary incisors and first molars as well as overjet and overbite. However, multiple negative effects were reported on the occlusal plane and lower incisors that need to be considered when using such appliance in treating Class II malocclusion.

Effects of skeletally anchored Class II elastics: A pilot study and new approach for treating Class II malocclusion

OBJECTIVE

To evaluate the skeletal, dentoalveolar, and soft tissue effects of skeletally anchored Class II elastics and compare them with a matched control group treated by a monobloc appliance for the correction of skeletal Class II malocclusion due to mandibular retrusion.

MATERIALS AND METHODS

Twelve patients (6 girls, 6 boys) were randomly divided into two groups. In the elastics group, six patients (12.9 ± 1.5 years of age; 3 boys, 3 girls) were treated with skeletally anchored Class II elastics. Two miniplates were placed bilaterally at the ramus of the mandible and the other two miniplates were placed at the aperture piriformis area of the maxilla. In the monobloc group (3 boys and 3 girls; mean age, 12.3 ± 1.6 years), patients used the monobloc appliance. The changes observed in each phase of treatment were evaluated using the Wilcoxon matched-pair sign test. Intergroup comparisons at the initial phase of treatment were analyzed by the Mann-Whitney U test.

RESULTS

There were statistically significant group differences in Co-Gn, B-VRL, U1-PP, U1-VRL, Ls-VRL, with significant increases in these parameters in the elastics group (P < .05). The mandibular incisors were protruded in the monobloc group (5.45 ± 1.23°), whereas they were retruded in the elastics group (-3.01 ± 1.66°; P < .01).

CONCLUSIONS

The undesirable dentoalveolar effects of the monobloc appliance were eliminated by using miniplate anchorage. Favorable skeletal outcomes can be achieved by skeletal anchorage therapies which could be an alternative to treat skeletal Class II patients with mandibular deficiency.

Class II subdivision treatment with the Forsus Fatigue Resistant Device vs intermaxillary elastics

OBJECTIVE

To compare the effectiveness of comprehensive fixed appliance treatments implemented in combination with Forsus or intermaxillary elastics in Class II subdivision subjects.

MATERIALS AND METHODS

Twenty-eight Class II subdivision patients were allocated to two groups using matched randomization: Forsus group (mean age, 14.19 ± 1.02 years) and elastics group (mean age, 13.75 ± 1.16 years). Patients received fixed appliance therapy in combination with either Forsus or intermaxillary elastics. The study was conducted on lateral cephalograms and digital models acquired before orthodontic treatment and 10-12 weeks after the fixed appliances were removed.

RESULTS

The treatment phase comprising the use of Forsus (4.53 ± 0.91 months) was significantly shorter compared with elastics application (6.85 ± 1.08 months). This was also true for comparing duration of overall comprehensive treatment in both groups. Extrusion and palatal tipping of maxillary incisors and clockwise rotation of the occlusal plane were greater in the elastics group (P < .05). The mandibular incisors were proclined in both groups (P < .001), but no significant difference was observed between groups (P > .05). The mandibular incisors showed intrusion in the Forsus group and extrusion in the elastics group; the difference between groups was significant (P < .05). Overbite was decreased in both groups (P < .001) in similar amounts. Improvement in overjet, mandibular midline deviation, and correction of molar relationship on the Class II side were greater in the Forsus group (P < .05).

CONCLUSION

Forsus is more effective for correcting Class II subdivision malocclusion in a shorter treatment period with minimal patient compliance required.

Treatment effects of fixed functional appliances in patients with Class II malocclusion: a systematic review and meta-analysis

OBJECTIVE

To assess the treatment effects of fixed functional appliances (FFAs) in treated versus untreated Class II patients by means of lateral cephalometric radiographs.

SEARCH METHODS

Unrestricted electronic search of 18 databases and additional manual searches up to October 2014.

SELECTION CRITERIA

Prospective randomized and non-randomized controlled trials reporting on cephalometric angular measurements of Class II patients treated with FFAs and their matched untreated controls.

DATA COLLECTION AND ANALYSIS

Skeletal, dental, and soft tissue cephalometric data were annualized and stratified according to the time of evaluation in effects. Following risk of bias evaluation, the mean differences (MDs) and 95 % confidence intervals (CIs) were calculated with random-effects models. Patient- and appliance-related subgroup analyses and sensitivity analyses were performed with mixed-effects models.

RESULTS

Nine studies were included (244 patients; mean age: 13.5 years and 174 untreated controls; mean age: 12.8 years) reporting on cephalometric effects directly after the removal of FFAs. FFAs were found to induce a small reduction of SNA angle (MD = -0.83 degree/year, 95 % CI: -1.17 to -0.48), a small increase of SNB angle (MD = 0.87 degree/year, 95 % CI: 0.30-1.43), and moderate decrease of ANB angle (MD = -1.74 degree/year, 95 % CI: -2.50 to -0.98) compared to untreated Class II patients. FFA treatment resulted in significant dentoalveolar and soft tissue changes. Several patient- or appliance-related factors seem to affect the treatment outcome. Long-term effectiveness of FFAs could not be assessed due to limited evidence.

CONCLUSIONS

According to existing evidence, FFAs seem to be effective in improving Class II malocclusion in the short term, although their effects seem to be mainly dentoalveolar rather than skeletal.

Analysis of Class II patients, successfully treated with the straight-wire and Forsus appliances, based on cervical vertebral maturation status

OBJECTIVE

To assess skeletal and dental changes in patients successfully treated with the Forsus appliance based on cervical vertebral maturation status.

METHODS

Forty-seven Class II patients, successfully treated with the Forsus appliance, were divided into peak and postpeak growth groups determined immediately prior to Forsus placement. The mean (SD) ages of the peak and postpeak groups were 13.4 (1.0) and 14.1 (1.3) years, respectively. Superimpositions of initial, Forsus placement, Forsus removal, and final cephalometric radiographs were completed, allowing the measurement of changes during three treatment phases.

RESULTS

There were no significant differences between groups during treatment phase 1 (alignment/leveling), with both groups demonstrating a worsening of the Class II molar relationship. However, during treatment phase 2 (Class II correction), patients within the peak group demonstrated significantly higher mean apical base, mandibular and molar changes, and an increased rate of change compared with those in the postpeak group. No significant differences were observed during treatment phase 3 (detail/finishing).

CONCLUSIONS

Following an initial worsening of the Class II molar relationship as a result of straight-wire appliance effects, Forsus appliance treatment initiated during cervical vertebral maturation status (CS) 3-4 elicits more effective and efficient correction of Class II molar relationships than when initiated during CS 5-6. Data support that these effects are due mainly to maxillary skeletal and dentoalveolar restraint during a period of more rapid mandibular growth.

Effects of miniplate anchored and conventional Forsus Fatigue Resistant Devices in the treatment of Class II malocclusion

OBJECTIVE

To compare the skeletal, dentoalveolar, and soft tissue effects of the miniplate anchored Forsus Fatigue Resistant Device (FRD) and the conventional Forsus FRD in the treatment of Class II malocclusion.

MATERIALS AND METHODS

The study was carried out with 30 patients (10 girls, 20 boys). In the MA-Forsus group, 15 patients (2 girls, 13 boys) were treated with a miniplate anchored Forsus FRD for 9.40 ± 2.25 months. In the C-Forsus group, 15 patients (8 girls, 7 boys) were treated with a conventional Forsus FRD for 9.46 ± 0.81 months. A total of 16 measurements were calculated and statistically analyzed to find intragroup and intergroup differences.

RESULTS

Statistically significant differences were found between the groups in IMPA, SN/Occ, SN/GoGn, overjet, overbite, and Li-S measurements (P < .05). In the C-Forsus group, a substantial amount of lower incisor protrusion was observed, whereas retrusion was found in the MA-Forsus group (P < .001). The mandible rotated backward in the MA-Forsus group, whereas it remained unchanged in the C-Forsus group (P < .05). Reductions in overjet (P < .001) and overbite were greater in the C-Forsus group (P < .05).

CONCLUSION

Stimulation of mandibular growth and inhibition of maxillary growth were achieved in both treatment groups. In the C-Forsus group, a substantial amount of lower incisor protrusion was observed, whereas retrusion of lower incisors was found in the MA-Forsus group. The MA-Forsus group was found to be more advantageous as it had no dentoalveolar side effects on mandibular dentition.

Treatment of Class II Division 2 Malocclusion Using the Forsus Fatigue Resistance Device and 5-Year Follow-Up

This case report presents the treatment of a 14-year-and-8-month-old boy with Class II division 2 mandibular retrusion, severe deep bite, and concave profile. The Forsus fatigue resistance device (FRD) was effective in correcting both skeletal and dental parameters. At 5-year posttreatment follow-up, the teeth were well aligned and the occlusion was stable. FRD application with appropriate treatment time can result with prominent changes in the facial profile and dentition, and the outcomes can be maintained at the long-term follow-up periods.

Changes in airway dimensions and hyoid bone position following class II correction with forsus fatigue resistant device

OBJECTIVE

The objective of this study was to investigate the effects of fixed functional therapy on oropharyngeal airway dimensions and hyoid bone positions in Class II patients and make comparison with an untreated Class II group.

MATERIALS AND METHODS

Eighteen patients (8 girls, 10 boys; mean age 13.62 ± 1.92 years) who were treated with Forsus Fatique Resistant Device (FFRD) and 19 patients (11 girls, 8 boys; mean age 12.74 ± 0.91 years) who served as control were enrolled. Cephalograms were used to assess linear, angular, and area measurements. Intragroup comparisons were made by paired t and Wilcoxon tests and intergroup comparisons were performed by independent t test.

RESULTS

With respect to controls, FFRD group showed increased airway dimensions at soft palate (P < 0.05) and more forward positioning of the hyoid bone (P < 0.05). Dentoalveolar changes exhibited mesial movement of lower incisors and molars and reduction in overjet (P < 0.001) in FFRD group.

CONCLUSIONS

Positive effects in oropharyngeal airway dimensions and increased values of hyoid bone displacement to a more forward position were found after fixed functional therapy.

CLINICAL RELEVANCE

Treatment with fixed functional appliances is mostly based on mesial movement of mandibular dentition, which might influence changes in tongue posture. The present results might indicate that oropharyngeal airway dimensions may be affected by postural changes of the hyoid bone in consequence of dentoalveolar changes. Clinically, these may be considered especially in Class II cases with reduced airway dimensions.

Treatment effects of skeletally anchored Forsus FRD EZ and Herbst appliances: A retrospective clinical study

OBJECTIVE

To evaluate the skeletal, dentoalveolar, and soft tissue effects of the Forsus FRD appliance with miniplate anchorage inserted in the mandibular symphyses and to compare the findings with a well-matched control group treated with a Herbst appliance for the correction of a skeletal Class II malocclusion due to mandibular retrusion.

MATERIALS AND METHODS

The sample consisted of 32 Class II subjects divided into two groups. Group I consisted of 16 patients (10 females and 6 males; mean age, 13.20 ± 1.33 years) treated using the Forsus FRD EZ appliance with miniplate anchorage inserted in the mandibular symphyses. Group II consisted of 16 patients (9 females and 7 males; mean age, 13.56 ± 1.27 years) treated using the Herbst appliance. Seventeen linear and 10 angular measurements were performed to evaluate and compare the skeletal, dentoalveolar, and soft tissue effects of the appliances using paired and Student's t-tests.

RESULTS

Both appliances were effective in correcting skeletal class II malocclusion and showed similar skeletal and soft tissue changes. The maxillary incisor was statistically significantly more retruded in the skeletally anchored Forsus FRD group (P < .01). The mandibular incisor was retruded in the skeletally anchored Forsus FRD group (-4.09° ± 5.12°), while it was protruded in the Herbst group (7.50° ± 3.98°) (P < .001).

CONCLUSION

Although both appliances were successful in correcting the skeletal Class II malocclusion, the skeletally anchored Forsus FRD EZ appliance did so without protruding the mandibular incisors.

Three-dimensional assessment of the temporomandibular joint and mandibular dimensions after early correction of the maxillary arch form in patients with Class II division 1 or division 2 malocclusion

Objective

This study aimed to assess three-dimensional changes in the temporomandibular joint positions and mandibular dimensions after correction of dental factors restricting mandibular growth in patients with Class II division 1 or division 2 malocclusion in the pubertal growth period.

Methods

This prospective clinical study included 14 patients each with Class II division 1 (group I) and Class II division 2 (group II) malocclusions. The quad-helix was used for maxillary expansion, while utility arches were used for intrusion (group I) or protrusion and intrusion (group II) of the maxillary incisors. After approximately 2 months of treatment, an adequate maxillary arch width and acceptable maxillary incisor inclination were obtained. The patients were followed for an average of 6 months. Intraoral and extraoral photographs, plaster models, and cone-beam computed tomography (CBCT) images were obtained before and after treatment. Lateral cephalometric and temporomandibular joint measurements were made from the CBCT images.

Results

The mandibular dimensions increased in both groups, although mandibular positional changes were also found in group II. There were no differences in the condylar position within the mandibular fossa or the condylar dimensions. The mandibular fossa depth and condylar positions were symmetrical at treatment initiation and completion.

Conclusions

Class II malocclusion can be partially corrected by achieving an ideal maxillary arch form, particularly in patients with Class II division 2 malocclusion. Restrictions of the mandible in the transverse or sagittal plane do not affect the temporomandibular joint positions in these patients because of the high adaptability of this joint.

Three-dimensional effects of the mini-implant-anchored Forsus Fatigue Resistant Device: A randomized controlled trial

OBJECTIVE

To detect three-dimensionally the effects of using mini-implant anchorage with the Forsus Fatigue Resistant Device (FFRD).

MATERIALS AND METHODS

The sample comprised 43 skeletal Class II females with deficient mandibles. They were randomly allocated into three groups: 16 patients (13.25 ± 1.12 years) received FFRD alone (Forsus group), 15 subjects (13.07 ± 1.41 years) received FFRD and mini-implants (FMI group), and 12 subjects (12.71 ± 1.44 years) were in the untreated control group. Three-dimensional analyses of cone beam computed tomographic images were completed, and the data were statistically analyzed.

RESULTS

Class I relationship and overjet correction were achieved in 88% of the cases. None of the two treatment groups showed significant mandibular skeletal effects. In the FMI group, significant headgear effect, decrease in maxillary width, and increase in the lower facial height were noted. In the FMI group, retroclination of maxillary incisors and distalization of maxillary molars were significantly higher. Proclination and intrusion of mandibular incisors were significantly greater in the Forsus group.

CONCLUSIONS

FFRD resulted in Class II correction mainly through dentoalveolar effects and with minimal skeletal effects. Utilization of mini-implant anchorage effectively reduced the unfavorable proclination and intrusion of mandibular incisors but did not produce additional skeletal effects.

Evaluation of the effects of skeletal anchoraged Forsus FRD using miniplates inserted on mandibular symphysis: A new approach for the treatment of Class II malocclusion

OBJECTIVE

To evaluate the skeletal, dentoalveolar, and soft tissue effects of the Forsus Fatigue Resistant Device (FRD) appliance with miniplate anchorage for the treatment of skeletal Class II malocclusion.

MATERIAL AND METHODS

The prospective clinical study group included 17 patients (11 girls and 6 boys; mean age 12.96 ± 1.23 years) with Class II malocclusion due to mandibular retrusion and treated with skeletal anchoraged Forsus FRD. After 0.019 × 0.025-inch stainless steel archwire was inserted and cinched back in the maxillary arch, two miniplates were placed bilaterally on the mandibular symphysis. Then, the Forsus FRD EZ2 appliance was adjusted to the miniplates without leveling the mandibular arch. The changes in the leveling and skeletal anchoraged Forsus FRD phases were evaluated by means of the Paired and Student's t-tests using the cephalometric lateral films.

RESULTS

The success rate of the miniplates was found to be 91.5% (38 of 42 miniplates). The mandible significantly moved forward (P < .001) and caused a significant restraint in the sagittal position of the maxilla (P < .001). The overjet correction (-5.11 mm) was found to be mainly by skeletal changes (A-VRL, -1.16 mm and Pog-VRL, 2.62 mm; approximately 74%); the remaining changes were due to the dentoalveolar contributions. The maxillary and mandibular incisors were significantly retruded (P < .001).

CONCLUSION

This new approach was an effective method for treating skeletal Class II malocclusion due to the mandibular retrusion via a combination of skeletal and dentoalveolar changes.

A comparison of the treatment effects of the Forsus Fatigue Resistance Device and the Twin Block appliance in patients with class II malocclusions

OBJECTIVES

We evaluated the skeletal and dentoalveolar effects of the Forsus Fatigue Resistance Device (FRD) and the Twin Block appliance (TB) in comparison with nontreated controls in the treatment of patients with class II division 1 malocclusion.

MATERIALS AND METHODS

THIS RETROSPECTIVE STUDY INCLUDED THREE GROUPS: TB (n=37; mean age, 11.2 years), FRD (n=30; mean age, 12.9 years), and controls (n=25; mean age, 12.6 years). Lateral cephalograms were evaluated at T1 (pretreatment) and at T2 (postappliance removal/equivalent time frame in controls). Cephalometric changes were evaluated using the Clark analysis, including 27 measurements.

RESULTS

Sagittal correction of class II malocclusion appeared to be mainly achieved by dentoalveolar changes in the FRD group. The TB was able to induce both skeletal and dentoalveolar changes. A favorable influence on facial convexity was achieved by both groups. Significant upper incisor retroclination occurred with the TB (-12.42°), whereas only -4° was observed in the FRD group. The lower incisors proclined more in the FRD group than the TB group. Incisor overjet reduction was 62% in the TB group versus 56% in the FRD group. Molar relation was corrected in both functional groups, resulting in a class I relation, although no change appeared in the control sample.

CONCLUSION

Both appliances were effective in correcting the class II malocclusion. Both the FRD and the TB induced significant maxillary and mandibular dentoalveolar changes; skeletal changes were induced by TB but not FRD therapy.

Treatment effects of a fixed intermaxillary device to correct class II malocclusions in growing patients

Background

The objective of this study was to evaluate the treatment effects of Forsus™ Fatigue Resistant Device (FRD; 3M Unitek, Monrovia, CA, USA) in growing patients with Class II non-extraction malocclusions.

Methods

A retrospective sample of 24 class II patients treated consecutively with the FRD followed by comprehensive orthodontic treatment was compared to a sample of untreated control subjects from the Bolton Brush Study who was matched in age, sex, and craniofacial morphology. Lateral cephalometric radiographs were taken before treatment (T1) and after removal of fixed appliances (T2). Growth changes were subtracted from the treatment changes to obtain the treatment effects of the appliance. Data were analyzed using ANOVA and a match paired t test.

Results

Significant differences were found between the treated and control groups for 12 of the 29 measured variables (Co-Gn minus Co-Apt, Wits, Is-OLp, Ii-OLp, overjet, Mi-OLp, molar relationship, overbite, Mic-ML, SNA, ANB, and Ii-ML). With 27.8 months of treatment, all patients were corrected to a class I dental arch relationship. Overjet and molar relationships were improved by an average of 4.7 and 3.1 mm, respectively. This was contributed by a 1.2 mm of restraint in forward maxillary growth, 0.7 mm of forward movement of the mandible, 1.5 mm of backward movement of the maxillary incisors, 1.3 mm forward movement of the mandibular incisors, 0.5 mm backward movement of the maxillary molars, and 1.3 mm of forward movement of the mandibular molars. The overbite was decreased by 2 mm with no significant change in the occlusal, palatal, or mandibular plane. Individual variations in response to the FRD treatment were large for most of the parameters tested. Significant differences in treatment changes between male and female subjects were found only in a few parameters measured.

Conclusions

These results demonstrate that significant overjet and overbite corrections can be obtained with the Forsus FRD in conjunction with comprehensive orthodontic treatment.

Upper airway changes after Xbow appliance therapy evaluated with cone beam computed tomography

OBJECTIVE

To determine the treatment effects of the Xbow appliance on the upper airway dimensions and volume using cone-beam computed tomography (CBCT); to evaluate the cephalometric changes in the skeletal and dental structures of the skeletal Class II patients.

MATERIALS AND METHODS

The sample consisted of 25 Class II patients (11 male, 14 female) with a mean age of 11.1 ± 1.1 years. CBCT images were obtained at the beginning of the treatment (T0) and after the debonding of the Xbow (T1).

RESULTS

Changes in superior, middle, and inferior parts of the oropharynx in the retroglossal region and changes in the oropharyngeal airway volume were statistically significant (P < .05, P < .01). The differences favoring the Xbow for the changes in the direction of Class II correction included SNA, SNB, ANB, maxillary depth angles, and point A-NPg and Co-B distances. Data of the dental parameters showed palatal tipping and extrusion of the maxillary incisors, labial tipping of the mandibular incisors, and mesial movement and extrusion of the mandibular molars.

CONCLUSIONS

Treatment with the Xbow appliance in Class II patients resulted in favorable increase in the oropharyngeal airway dimensions and volume. Further studies with larger study samples and with control groups are needed.

Treatment of a skeletal Class II malocclusion using fixed functional appliance with miniplate anchorage

Based on our literature search, we found that the use of miniplate anchorage with Forsus fatigue-resistance device (FRD) has not yet been reported. Therefore, the aim of the present case report was to present the treatment of a patient with skeletal Class II malocclusion with mandibular retrusion using Forsus FRD with miniplate anchorage. Fixed appliances with 0.022-inch slots were attached to the maxillary teeth and after 8 months of the leveling and alignment of the upper arch, 0.019 × 0.025-inch stainless steel archwire was inserted and cinched back. Two weeks after the placement of the miniplates bilaterally at the symphysis of the mandible, Forsus FRD was adjusted to the miniplates with a 35-mm length of rod chosen. Nine months after the skeletal anchored Forsus worn, Class I canine and molar relations were achieved and overjet was eliminated.

Use of Forsus fatigue-resistant device in a patient with Class I malocclusion and mandibular incisor agenesis

Orthodontic treatment in patients with congenitally missing teeth can be challenging. In this case report, we describe the treatment of a 15-year-old girl with mild dental crowding and 2 congenitally missing mandibular incisors. The Forsus fatigue-resistant device was used to move the mandible and the mandibular teeth forward. A new balanced and stable occlusion was achieved after treatment. When the treatment plan includes moving the mandibular teeth forward in a patient with mandibular incisor agenesis, the profile and the skeletal and dental features should be carefully scrutinized to ensure that balanced and esthetic results are achieved.

Active-treatment effects of the Forsus fatigue resistant device during comprehensive Class II correction in growing patients

OBJECTIVE

To evaluate the active-treatment effects of the Forsus fatigue resistant device (Forsus) during comprehensive correction of Class II malocclusion in growing patients.

METHODS

Fifty-four patients (mean age, 12.5 ± 1.2 years) with Class II division 1 malocclusion were consecutively treated with fixed app-liances in combination with Forsus. Lateral cephalograms were analyzed at the beginning of the fixed treatment (T1), Forsus insertion (T2), its removal (T3), and end of the comprehensive therapy (T4). Statistical comparisons were carried out by repeated-measures ANOVA with Tukey's post-hoc test (p < 0.05).

RESULTS

The overall therapeutic effects were mainly dentoalveolar and occurred mostly during the active treatment with Forsus (T2-T3, mean duration = 0.5 ± 0.1 years). The overjet and overbite decreased significantly (-3.5 and -1.5 mm, respectively) and the molar relationship improved by 4.3 mm. These changes were associated with significant retroclination of the maxillary incisors (-3.1°), proclination and intrusion of the mandibular incisors (+5.0° and -1.5 mm, respectively), and mesialization of the mandibular molars (+2.0 mm).

CONCLUSIONS

Forsus had mainly dentoalveolar effects and contributed largely to the overall therapeutic outcome.

Treatment and posttreatment effects induced by the Forsus appliance: A controlled clinical study

OBJECTIVE

To evaluate treatment and posttreatment dentoskeletal effects induced by the Forsus device (FRD) in growing patients with Class II malocclusion in a retrospective controlled clinical study.

MATERIALS AND METHODS

Thirty-six Class II patients (mean [SD] age 12.3 [1.2] years) were treated consecutively with the FRD protocol and compared with a sample of 20 subjects with untreated Class II malocclusion (mean [SD] age 12.2 [0.9] years). Lateral cephalograms were taken at the beginning of treatment, at the end of comprehensive treatment (after 2.3 ± 0.4 years), and at a postretention period (after 2.3 ± 1.1 years from the end of comprehensive treatment). Statistical comparisons were carried out with the unpaired t-test and Benjamini-Hochberg correction (P < .05).

RESULTS

After comprehensive treatment, the FRD sample showed a significant restriction of the sagittal maxillary growth together with a significant correction in overjet, overbite, and molar relationship. During the overall observation interval, the FRD group exhibited no significant sagittal or vertical skeletal changes, while significant improvements were recorded in overjet (-3.8 mm), overbite (-1.5 mm), and molar relationship (+3.7 mm).

CONCLUSION

The FRD protocol was effective in correcting Class II malocclusion mainly at the dentoalveolar level when evaluated 2 years after the end of comprehensive treatment.

Temporomandibular joint changes after activator appliance therapy: a prospective magnetic resonance imaging study

The aim of this prospective clinical and magnetic resonance imaging study was to analyze the effect of 1-year Activator (Yi-fan Dental Co., Shanghai, China) treatment in internal anatomical relationships of the temporomandibular joint (TMJ) complex, including the condyle-disc relationship, condyle-fossa relationship, condylar height change, disc length change, and morphologic change of the glenoid fossa. The study was composed of patients with class II division 1 malocclusion (11 girls and 13 boys) who underwent 1-year Activator treatment. All the patients were in the acceleration or peak phase of the pubertal growth spurt. Magnetic resonance imaging in closed-mouth position and lateral cephalometric radiographs before and after 1 year of Activator treatment were analyzed metrically. Overall, condylar height showed a significant increase (P < 0.001), and the eminence angle decreased (P = 0.037). TMJ disc length has no statistically significant change before and after treatment. A slight advancement (P = 0.041) was found in the sagittal condylar position. A significant backward movement (P = 0.04) was shown in the sagittal disc position. Our results showed that the disc is not impaired by Activator therapy; it seems possible that adaptive remodeling, including a shallower glenoid fossa and increased condylar height, was seen after treatment.

Morphological Changes of Condyles and Helkimo Clinical Dysfunction Index in Patients Treated with Herbst - Orthodontic Appliance

This study evaluated the morphological changes in the temporomandibular joint (TMJ) condyles and calculated the Helkimo clinical dysfunction index (CDI) in adolescents with Class II Division 1 malocclusion and mandibular retrognathism treated with the Herbst appliance (phase I) and fixed orthodontic appliances (phase II). Thirty-two consecutive adolescents underwent phase I, and 23 completed phase II. The TMJs were evaluated qualitatively using magnetic resonance imaging (MRI) at the beginning of treatment (T1), during phase I (T2), at the end of phase I (T3) and at the end of phase II (T4). The CDI was calculated at T1, T3 and T4. From T1 to T3 (p=0.326), there were no changes in condyle morphology in 86.0% of the TMJs. From T3 to T4 (p<0.05) and T1 to T4 (p<0.05), changes occurred in 39.1% and 43.4% of the condyles. No significant changes in CDI occurred from T1 to T3, T3 to T4 and T1 to T4 (p=1.000; 86.6%, 76.2% and 76.2% concordance). After phase I, there were practically no changes in condyle morphology. At the end of phase II, a mild flattening was observed in some condyles. It may be concluded that no significant changes occurred in CDI after both treatment phases.

Treatment effects of the Forsus Fatigue Resistant Device used with miniscrew anchorage

OBJECTIVE

To evaluate the dentofacial effects of the Forsus Fatigue Resistant Device (FRD) used with miniscrew anchorage (FRDMS) and compare them with those of conventional FRD and an untreated Class II control group.

MATERIALS AND METHODS

The sample consisted of 48 Class II subjects. Sixteen patients (13.68 ± 1.09 years of age) were treated with FRDMS, whereas 17 subjects (14.64 ± 1.56 years of age) were treated with only FRD. Also, a control sample of 15 untreated Class II subjects (14.13 ± 1.50 years of age) was constructed. Angular and linear measurements were made on 96 lateral cephalograms. Paired t, one-way analysis of variance, and Tukey tests were used for statistical analysis.

RESULTS

Class I molar relationship and overjet correction were achieved in an average period of 6.5 ± 1.97 and 5.5 ± 1.80 months in the FRDMS and FRD groups, respectively. No skeletal effect was determined in both treatment groups. Greater overbite correction was found in the FRD group. Retrusion and extrusion of maxillary incisors, distalization of maxillary molars, and extrusion of mandibular molars were significant in both treatment groups. Labial tipping of mandibular incisors was significantly greater in the FRD group than in the FRDMS group.

CONCLUSION

Overjet and molar correction was totally dentoalveolar. Unfavorable labial tipping of mandibular incisors was effectively minimized with the usage of miniscrews.