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

Temporary anchorage devices in orthodontics: a bibliometric analysis of the 50 most-cited articles from 2012 to 2022

OBJECTIVES

To identify and analyze the 50 most cited articles on temporary anchorage devices (TADs) and investigate the achievement and development of scientific research about the topic through a bibliometric analysis.

MATERIALS AND METHODS

On August 22, 2022, a computerized database search was performed to detect papers published in the scientific literature about TADs from 2012 to 2022. Metrics data were identified using the Incites Journal Citation Reports (Clarivate Analytics) data set. The Scopus database was used to obtain information on the authors' affiliations, country of origin, and h-index. Key words were automatically harvested from the selected articles to implement the visualized analysis.

RESULTS

From a total of 1858 papers screened by searching the database, a list of the top 50 most cited articles was created. The total number of citations collected by the 50 most cited articles in TADs was 2380. Among the 50 most cited articles on TADs, 38 were original research papers (76.0%) and 12 were reviews (24.0%). As shown by the key word-network analysis, Orthodontic anchorage procedure was identified as the larger node.

CONCLUSIONS

Findings of this bibliometric study showed an increasing number of citations for papers on TADs, accompanied by a simultaneous rise in scientific interest in this topic in the past decade. The present work identifies the most influential articles, emphasizing the journals, the authors, and the topics addressed.

Skeletal Class II Malocclusion: From Clinical Treatment Strategies to the Roadmap in Identifying the Genetic Bases of Development in Humans with the Support of the Collaborative Cross Mouse Population

Depending on how severe it is, malocclusion, which may involve misaligned teeth, jaws, or a combination of the two, can hurt a person's overall facial aesthetics. The maxillary molar develops before the mandibular molar in class II malocclusion, which affects 15% of the population in the United States. With a retrusive mandible, patients typically have a convex profile. The goal of this study is to classify the skeletal and dental variability present in class II malocclusion, to reduce heterogeneity, present the current clinical treatment strategies, to summarize the previously published findings of genetic analysis, discuss these findings and their constraints, and finally, propose a comprehensive roadmap to facilitate investigations aimed at determining the genetic bases of malocclusion development using a variety of genomic approaches. To further comprehend the hereditary components involved in the onset and progression of class II malocclusion, a novel animal model for class II malocclusion should be developed while considering the variety of the human population. To overcome the constraints of the previous studies, here, we propose to conduct novel research on humans with the support of mouse models to produce contentious findings. We believe that carrying out a genome-wide association study (GWAS) on a large human cohort to search for significant genes and their modifiers; an epigenetics-wide association study (EWAS); RNA-seq analysis; integrating GWAS and the expression of quantitative trait loci (eQTL); and the testing of microRNAs, small RNAs, and long noncoding RNAs in tissues related to the skeletal class II malocclusion (SCIIMO) phenotype, such as mandibular bone, gum, and jaw in humans and the collaborative cross (CC) mouse model, will identify novel genes and genetic factors affecting this phenotype. We anticipate discovering novel genetic elements to advance our knowledge of how this malocclusion phenotype develops and open the venue for the early identification of patients carrying the susceptible genetic factors so that we can offer early prevention treatment strategies.

Effects of skeletal anchorage on mandibular rotation with fixed functional appliance therapy in class II malocclusion patients – A systematic review and meta-analysis

Objectives:

The study aimed to systematically investigate the effect of skeletal anchorage on mandibular rotation during FFA therapy during Class II correction in adolescents.

Material and Methods:

The review protocol was registered under the PROSPERO database (CRD42021256690). Electronic searches of databases and screening were performed up to May 2022. Only randomized clinical trials (RCT) and non-randomized controlled trials (non-RCT) were included in the study. Revised Cochrane risk-of-bias tool for RCTs (RoB 2) and risk of bias in non-randomized studies-of interventions tool for non-RCT were used for studies. Meta-analysis was performed and a forest plot was obtained. The primary outcome was mandibular rotation. Other outcomes assessed were angles SNA, SNB, ANB, mandibular incisor proclination, and failure rates of mini-screws and mini plates.

Results:

Twelve studies (eight RCTs and four non-RCTs) were included fulfilling inclusion criteria. Evidence showed a low-to-moderate risk of bias for different domains. Meta-analysis for mandibular rotation revealed a greater increase in mandibular plane angle in patients who received FFA with skeletal anchorage as compared to patients who did not receive skeletal anchorage.

Conclusion:

With or without skeletal anchorage, mandibular rotational changes during FFA therapy are similar. FFA when combined with skeletal anchorage causes more skeletal changes in sagittal parameters than conventional FFA used alone. FFA with skeletal anchorage reduces lower incisor proclination.

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.

Skeletal and dentoalveolar effects of class II malocclusion treatment using bi-maxillary skeletal anchorage: a systematic review

BACKGROUND

The goal of this systematic review was to assess the available evidence regarding the skeletal and dentoalveolar effects of bi-maxillary skeletal anchorage devices (BMSADs) used in treating growing class II malocclusion patients.

METHODS

A comprehensive search was conducted on PubMed, Scopus, Science Direct, Web of Science, Cochrane, and LILACS up to November 2021, which was augmented by a manual search. The studies included were clinical trials (RCTs) and/or follow-up observational studies (retrospective and prospective). The outcomes of interest were the skeletal, dentoalveolar, and occlusal treatment-induced changes obtained from pre- and post-cephalometric measurements. The risks of bias of the included studies were assessed using an assessment tool from previous publications.

RESULTS

Out of 742 screened articles, only 4 were eligible and thus included in the qualitative synthesis. They showed a moderate overall risk of bias. The results are presented as mean changes in both the study and control groups. All studies reported retrusion of the maxillary base and advancement of the mandible (meaning reduced ANB angle). Three of the included studies reported an increase in the vertical jaw relation, which was contrary to what the fourth study reported. Three studies reported an increase in the maxillary incisors' inclination or position, while one study reported their retroclination. Proclination of the mandibular incisors happened in two studies, whereas the other two studies reported retroclination. The overjet was reduced in all included studies.

CONCLUSION

Apart from the protrusive effects on the mandible, retrusive effects on the maxilla, and the consequent reduction of the overjet, BMSADs results in inconsistent skeletal and dentoalveolar effects. However, the current evidence is limited due to the variability in the biomechanics of the intermaxillary components, type of anchorage, and comparable groups in the included studies. Further RCTs with more standardized methodologies are highly encouraged.

CLINICAL RELEVANCE

BMSADs (using miniscrews or miniplates on both jaws) induces more skeletal than dentoalveolar effects. However, this must be practiced with caution, based on the benefit to risk (surgical insertion) ratio, and the limited evidence available in hand so far. Registration The protocol for this systematic review was registered at the International Prospective Register of Systematic Reviews (PROSPERO, No.: CRD42020199601).

Success rate of surface-treated and non-treated orthodontic miniscrews as anchorage reinforcement in the lower arch for the Herbst appliance: A single-centre, randomised split-mouth clinical trial

BACKGROUND

Surface treatment of miniscrews was implemented to determine whether its application increased bone-to-surface contact and enhanced the interlock between the device and the surrounding bone.

OBJECTIVES

To compare the success rate of surface-treated and non-treated orthodontic miniscrews used as reinforcement of anchorage during treatment with the Herbst appliance.

TRIAL DESIGN

Split-mouth design with an allocation ratio of 1:1.

METHODS

Eligibility criteria to enrol patients were skeletal and dental class II patients with a retrusive chin, use of the Herbst appliance to correct malocclusion, need for skeletal anchorage using a miniscrew both in the left and right side of the mouth, absence of systemic diseases, absence of using drugs that alter bone metabolism, and good oral hygiene. Patients received self-drilling miniscrews without surface treatment and with surface treatment. Both types presented a 1.4 or 1.2 mm diameter. Miniscrews were inserted between the first molar and second premolars or between the two premolars. The force applied to the screws was an elastic chain from the head of the miniscrews to a direct button applied on the canines. The success rate of each type of miniscrew was considered the primary outcome, and the association of success with demographical, clinical, and geometrical characteristics was investigated. Differences were tested by the generalised linear mixed effects model for the split-mouth design. Differences with a P-value < 0.05 were selected as significant.

RANDOMISATION

A randomisation list was created for the mouth side assignment.

BLINDING

The study was single blinded with regard to the statistical analysis.

RESULTS

Thirty-nine miniscrews of the non-treated type and 39 miniscrews of the surface-treated type were inserted in 39 patients (23 female and 16 male, mean age: 15.55 ± 7.91) recruited between March 2018 and December 2020 with a split-mouth study design. The mean therapy duration was 9.3 months (SD = 1.31). No differences in failure rate were observed between miniscrew types. No serious harm was observed.

CONCLUSIONS

The success rate of surface-treated and non-treated miniscrews showed no significant differences.

REGISTRATION

This trial was not registered.

ADDING TEMPORARY ANCHORAGE DEVICES (TADs) TO THE FORSUS™ CLASS II CORRECTION SYSTEM MAY NOT ENHANCE THE SAGITTAL SKELETAL EFFECTS BUT MAY CONTROL THE INCLINATION OF THE MANDIBULAR INCISORS

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION

A comparison of the effects of Forsus appliances with and without temporary anchorage devices for skeletal Class II malocclusion. Liu L, Zhan Q, Zhou J, Kuang Q, Yan X, Zhang X, Shan Y, Lai W, Long H. Angle Orthod. 2020 Dec 30. doi:10.2319/051120-421.1. Epub ahead of print. PMID: 33378419.

SOURCE OF FUNDING

National Natural Science Foundation of China (No. 82,071,147, 81,571,004, and 81,500,884).

TYPE OF STUDY/DESIGN

Systematic review with meta-analysis.

Steering the Mandible in the Right Direction : Forsus Case Series

We are in the process of discovery of new vistas for technological advances in terms of various appliances with a vision of making orthodontic treatment compliance free as well as successful. Due to improved technology, the enigma of treating the Class II syndrome is palliated. “Out of the box” thinking has become a norm to treat certain situations that were not corrected in noncompliant patients. Fixed functional appliances are valuable tools introduced to assist the correction of skeletal Class II malocclusion with mandibular retrognathia at the deceleration stage of growth for achieving stable results. In this direction a case series is reported of patients having the above conditions and undergoing orthodontic treatment using a Forsus FFA. Joining hands with technology is a win-win situation for both the patient and the orthodontist.

Class ii treatment effects with fixed functional appliances: jasper jumper vs. forsus fatigue resistant device

OBJECTIVE

This study aimed to compare cephalometric changes of Class II malocclusion patients treated with Jasper Jumper and Forsus, associated with fixed appliances.

METHODS

The sample consisted of 62 individuals divided into 3 groups: group 1 included 22 subjects with a mean initial age of 12.39 years, treated with Jasper Jumper associated with fixed appliances for a mean period of 2.43 years; group 2 included 19 subjects with a mean initial age of 12.43 years, treated with Forsus associated with fixed appliances for a mean period of 3.54 years; and group 3 included 22 Class II malocclusion untreated subjects at a mean age of 12.14 years, followed for a mean period of 1.78 years. Intergroup comparison was performed with one-way ANOVA, followed by Tukey test.

RESULTS

Both treated groups had similar dentoskeletal changes: restrictive effect on the maxilla; clockwise rotation of the occlusal plane; mild increase in lower anterior facial height; limitation on the vertical development of the maxillary molars; labial tipping and intrusion of the mandibular incisors; extrusion of mandibular molars; improvements of the maxillomandibular relationship, overjet, overbite, molar relationship; and retrusion of the upper lip. The mandibular incisors exhibited greater protrusion in group 1 compared to the other groups. In addition, group 2 presented mild protrusion of the lower lip, and groups 1 and 3 showed mild retrusion.

CONCLUSION

The Jasper Jumper and Forsus appliances were effective and showed similar changes in the treatment of Class II malocclusion.

Skeletal and dental effects of Herbst appliance anchored with temporary anchorage devices: A systematic review with meta-analysis

BACKGROUND

The aim was to evaluate the efficiency of using temporary anchorage devices (TADs) in minimizing the anchorage loss and increasing the skeletal effects during correction of Class II malocclusion with Herbst appliance.

MATERIALS AND METHODS

Search without restrictions was performed up to January 2021 in three electronic databases (CENTRAL, MEDLINE and EMBASE) for randomized controlled trials (RCTs), prospective and retrospective cohort studies. The included studies assessed the dental and skeletal changes in Class II malocclusion patients who were treated using Herbst appliance with or without TADs. The strength of evidence was ranked using GRADE.

RESULTS

Fifty-five records were initially retrieved. A total of 6 studies with 198 patients were finally considered. 4 studies were included in the meta-analysis. The meta-analysis showed that using TADs with acrylic splint Herbst appliance was effective in controlling the inclination of mandibular incisors by a mean difference of -5.49 degrees (95% C.I [-7.36, -3.63], P < .001) when compared to Herbst appliance alone. The results showed also that incorporating TADs with Herbst treatment resulted in greater mandibular skeletal effects including increasing mandibular bone base length by mean difference of 2.22 mm (95% C.I [0.82. 3.61], P = .002) and mandibular length by mean difference of 3.7 mm (95% C.I [1.55, 5.85], P < .001) when compared to Herbst appliance alone.

CONCLUSIONS

Based on a very low level of confidence, it seems that incorporating TADs during orthodontic treatment with Herbst appliance results in minimizing the anchorage loss and increasing the skeletal effects of Herbst appliance during correction of Class II malocclusion.

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.

Effects of miniplate anchored Herbst appliance on skeletal, dental and masticatory structures of the craniomandibular apparatus: A finite element study

OBJECTIVE

To analyze the stress distribution in the hard and soft tissue structures of craniomandibular complex during mandibular advancement with miniplate anchored rigid fixed functional appliance (FFA) using Finite Element Analysis (FEA).

MATERIAL AND METHODS

The virtual model consisting of all the maxillofacial bones (up to calvaria), the mandible and temporomandibular joint (TMJ) was generated using the volumetric data from pre-treatment CBCT-scan of a growing patient. The masticatory muscles, other soft tissues, Herbst appliance and plate geometry were modelled mathematically. Force vectors simulating muscle contraction at rest and advanced mandibular positions, with protraction force of 8N were applied. The final model was imported into ANSYS for analysis after assigning material properties.

RESULTS

The maximum von Mises stress of 11.69MPa and 11.96MPa magnitude was observed in the region of pterygoid plates and at the bone-miniplate interface respectively, with the mandibular advancement of 7mm. Stress patterns were also noted at the condylar neck. The stress values observed in the medial and lateral pterygoid muscles were of 10.42MPa and 4.16MPa magnitude, respectively. Stress was noted in the bucco-cervical region of the upper posterior teeth, but negligible change was seen on the lower anterior teeth and periodontal ligament.

CONCLUSION

Miniplate Anchored Herbst Appliance brought about Class II skeletal correction in growing children as it was accompanied by minimal changes in the inclination of the lower incisors. Soft tissue structures like pterygoid muscles and discal ligaments exhibited increased stress whereas masseter muscle displayed reduction in stresses.

Effects of fixed functional appliances with temporary anchorage devices on Class II malocclusion: A systematic review and meta‑analysis

BACKGROUND

The use of fixed functional appliances (FFAs) in conjunction with temporary anchorage devices (TADs) has been proposed to enhance skeletal changes and reduce proclination of the lower incisors.

OBJECTIVES

To systematically investigate the skeletal and dentoalveolar effects of FFAs with TADs on Class II malocclusion in adolescents.

METHODS

Electronic searches of databases and manual searches of references were performed up to August 30, 2020. Randomized controlled trials (RCTs) and clinical controlled trials (CCTs) focusing on adolescent patients treated with FFAs combining TADs were included. The modified Cochrane risk-of-bias tool (R.O.B 2.0) and ROBINS-I (Risk of Bias in Non-randomized Studies-of Interventions) Tool were used to assess the risk of bias in RCTs and CCTs, respectively. Meta-analyses of SNA, SNB, ANB, Co-Gn, SN-MP, the lower and upper incisor inclination changes were performed. Subgroup analyses and sensitivity analyses were conducted based on TAD types, FFA types, record types and types of study designs.

RESULTS

Ten studies were included with a sample size of 281. Meta-analyses revealed significant differences in the changes in SNB (mean difference [MD] 0.67; 95% confidence interval [CI] 0.04-1.29), ANB (MD -1.22, 95% CI -2.04 to -0.39), Co-Gn (MD 1.57; 95% CI 0.22-2.92), inclination of the lower incisors (MD -5.64, 95% CI -7.78 to -3.50)] and inclination of the upper incisors (MD -1.91; 95% CI -3.69 to -0.13). TAD types and FFA types seem to affect the treatment outcome.

CONCLUSIONS

Compared with FFAs alone, FFAs with TADs exhibit superior skeletal effects and reduce the inclination of the lower incisors in the short term; however, the evidence showed moderate to high risk of bias. Registration number CRD42020177611.

A comparison of the effects of Forsus appliances with and without temporary anchorage devices for skeletal Class II malocclusion

OBJECTIVES

To compare the effects of Forsus appliances with and without temporary anchorage devices (TADs) for patients with skeletal Class II malocclusion.

MATERIALS AND METHODS

Through a predefined search strategy, electronic searching was conducted in PubMed, Embase, Web of Science, CENTRAL, ProQuest Dissertations & Theses, and SIGLE with no language restrictions. Eligible study selection, data extraction, and evaluation of risk of bias (Cochrane Collaboration tool) were conducted by two authors independently and in duplicate. Any disagreement was solved by discussion or judged by a third reviewer. Statistical pooling, sensitivity analysis, subgroup analysis, and assessment of small-study effects were conducted by using Comprehensive Meta-Analysis and Stata 12.0. Heterogeneity was analyzed for different types of study designs, TADs, and radiographic examinations.

RESULTS

Electronic search yielded a total of 256 studies after removing duplicates. Among them, six studies were finally included. All articles were of high quality. The pooled mean differences were -0.27 (95% confidence interval [CI]: -0.59, 0.05) for SNA, 0.58 (95% CI: -0.07, 1.23) for SNB, -0.86 (95% CI: -1.74, -0.03) for ANB, 1.63 (95% CI: 0.46, 2.80) for Co-Po, 0.75 (95% CI: 0.28, 1.23) for SN-MP, -7.56 (95% CI: -11.37, -3.76) for L1-MP, 0.47 (95% CI: -0.98, 1.91) for overjet, 0.39 (95% CI: -0.57, 1.35) for overbite, -1.84 (95% CI: -5.15, 1.47) for SN-OP, and 4.97 (95% CI: -1.22, 11.17) for nasolabial angle.

CONCLUSIONS

TADs (especially miniplates) were able to eliminate dental adverse effects of Forsus appliances for correction of skeletal Class II malocclusion.

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.

Skeletally anchored forsus fatigue resistant device for correction of Class II malocclusions-A systematic review and meta-analysis

The use of skeletal anchorage with fixed functional appliances (FFA) has been proposed by various authors to produce skeletal changes and reduce lower incisor proclination. To compare the skeletal and dentoalveolar effects of Forsus Fatigue Resistant Device (FFRD) with or without skeletal anchorage (miniplates and mini-implants). The electronic database PubMed, Cochrane Library, Medline, Embase and Google Scholar along with a manual search of orthodontic journals till the year 2019. Only randomized control trials (RCTs) were included in the systematic review. One controlled clinical trial (CCT) which involved FFRD was included in the review since it was a continuation of an RCT which was expanded to a CCT. Skeletal and dentoalveolar outcome data were extracted to collect study characteristics. After evaluating risk of bias, the standardized mean differences (SMDs) and 95% confidence intervals (CIs) were calculated. Three RCTs and one prospective CCT were evaluated. The analysis included data from 116 Class II subjects [(58) treated with FFA along with skeletal anchorage and (58) treated with FFA]. There were no significant difference between the two groups with respect to mandibular length changes (P value = .10) and SNB angle changes (P value = .22). With respect to lower incisor inclination however, there was a significant difference between the two groups (P value = .005) signifying better results with respect to skeletal anchorage. The studies reviewed provide insufficient evidence to form a conclusion regarding the effects of the use of skeletal anchorage with FFRD. The available weak evidence suggests that the use of skeletal anchorage with FFRD has no superior skeletal effects but is able to reduce proclination of the lower incisors. Control of lower incisor proclination remains the most significant advantage of skeletal reinforcement, and miniplate-anchored FFRD showed more promising results in preventing lower incisor proclination than miniscrew-anchored FFRD.

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.

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.

Temporary Skeletal Anchorage Techniques

As orthodontic treatment has advanced in complexity and in frequency, more recent techniques, using temporary skeletal anchorage, were developed to help correct more severe occlusal and dentofacial discrepancies that were treated with orthognathic surgery alone previously. These techniques have allowed the orthodontist to move teeth against a rigid fixation, allowing for more focused movements of teeth and for orthopedic growth modification. These types of treatments using rigid fixation have allowed for greater interaction between the orthodontist and the oral and maxillofacial surgeon, and have vastly enhanced the treatment planning for the orthodontist in today's society.

Four TADs supported Herbst mechanics: A case report

The Herbst appliance (HA) is considered an efficient method to treat class II malocclusion characterized by mandibular retrusion. Nevertheless, HA is although hampered by side effects reducing its therapeutic potentialities. The association between HA and TADs in the lower arch has proved to be very effective in controlling lower incisor flaring. This case report shows that the insertion of TADs in both arches offers a satisfactory control of the vertical dimension, by avoiding a maxillary clockwise inclination.

Evaluation of the miniplate-anchored Forsus Fatigue Resistant Device in skeletal Class II growing subjects: A randomized controlled trial

OBJECTIVES

To evaluate the use of direct miniplate anchorage in conjunction with the Forsus Fatigue Resistant Device (FFRD) in treatment of skeletal Class II malocclusion.

MATERIALS AND METHODS

Forty-eight females with skeletal Class II were randomly allocated to the Forsus plus miniplates (FMP) group (16 patients, age 12.5 ± 0.9 years), Forsus alone (FFRD; 16 patients, age 12.1 ± 0.9 years), or the untreated control group (16 subjects, age 12.1 ± 0.9 years). After leveling and alignment, miniplates were inserted in the mandibular symphysis in the FMP group. The FFRD was inserted directly on the miniplates in the FMP group and onto the mandibular archwires in the FFRD group. The appliances were removed after reaching an edge-to-edge incisor relationship.

RESULTS

Data from 46 subjects were analyzed. The effective mandibular length significantly increased in the FMP group only (4.05 ± 0.78). The mandibular incisors showed a significant proclination in the FFRD group (9.17 ± 2.42) and a nonsignificant retroclination in the FMP group (-1.49 ± 4.70). The failure rate of the miniplates was reported to be 13.3%.

CONCLUSIONS

The use of miniplates with the FFRD was successful in increasing the effective mandibular length in Class II malocclusion subjects in the short term. The miniplate-anchored FFRD eliminated the unfavorable mandibular incisor proclination in contrast to the conventional FFRD.

Role of anatomical sites and correlated risk factors on the survival of orthodontic miniscrew implants: a systematic review and meta-analysis

Objectives

The aim of this review was to systematically evaluate the failure rates of miniscrews related to their specific insertion site and explore the insertion site dependent risk factors contributing to their failure.

Search methods

An electronic search was conducted in the Cochrane Central Register of Controlled Trials (CENTRAL), Web of Knowledge, Scopus, MEDLINE and PubMed up to October 2017. A comprehensive manual search was also performed.

Eligibility criteria

Randomised clinical trials and prospective non-randomised studies, reporting a minimum of 20 inserted miniscrews in a specific insertion site and reporting the miniscrews’ failure rate in that insertion site, were included.

Data collection and analysis

Study selection, data extraction and quality assessment were performed independently by two reviewers. Studies were sub-grouped according to the insertion site, and the failure rates for every individual insertion site were analysed using a random-effects model with corresponding 95% confidence interval. Sensitivity analyses were performed in order to test the robustness of the reported results.

Results

Overall, 61 studies were included in the quantitative synthesis. Palatal sites had failure rates of 1.3% (95% CI 0.3–6), 4.8% (95% CI 1.6–13.4) and 5.5% (95% CI 2.8–10.7) for the midpalatal, paramedian and parapalatal insertion sites, respectively. The failure rates for the maxillary buccal sites were 9.2% (95% CI 7.4–11.4), 9.7% (95% CI 5.1–17.6) and 16.4% (95% CI 4.9–42.5) for the interradicular miniscrews inserted between maxillary first molars and second premolars and between maxillary canines and lateral incisors, and those inserted in the zygomatic buttress respectively. The failure rates for the mandibular buccal insertion sites were 13.5% (95% CI 7.3–23.6) and 9.9% (95% CI 4.9–19.1) for the interradicular miniscrews inserted between mandibular first molars and second premolars and between mandibular canines and first premolars, respectively. The risk of failure increased when the miniscrews contacted the roots, with a risk ratio of 8.7 (95% CI 5.1–14.7).

Conclusions

Orthodontic miniscrew implants provide acceptable success rates that vary among the explored insertion sites. Very low to low quality of evidence suggests that miniscrews inserted in midpalatal locations have a failure rate of 1.3% and those inserted in the zygomatic buttress have a failure rate of 16.4%. Moderate quality of evidence indicates that root contact significantly contributes to the failure of interradicular miniscrews placed between the first molars and second premolars. Results should be interpreted with caution due to methodological drawbacks in some of the included studies.

Electronic supplementary material

The online version of this article (10.1186/s40510-018-0225-1) contains supplementary material, which is available to authorized users.

Orthodontic treatment for prominent upper front teeth (Class II malocclusion) in children and adolescents

BACKGROUND

Prominent upper front teeth are a common problem affecting about a quarter of 12-year-old children in the UK. The condition develops when permanent teeth erupt. These teeth are more likely to be injured and their appearance can cause significant distress. Children are often referred to an orthodontist for treatment with dental braces to reduce the prominence of their teeth. If a child is referred at a young age, the orthodontist is faced with the dilemma of whether to treat the patient early or to wait and provide treatment in adolescence.

OBJECTIVES

To assess the effects of orthodontic treatment for prominent upper front teeth initiated when children are seven to 11 years old ('early treatment' in two phases) compared to in adolescence at around 12 to 16 years old ('late treatment' in one phase); to assess the effects of late treatment compared to no treatment; and to assess the effects of different types of orthodontic braces.

SEARCH METHODS

Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 27 September 2017), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2017, Issue 8), MEDLINE Ovid (1946 to 27 September 2017), and Embase Ovid (1980 to 27 September 2017). The US National Institutes of Health Ongoing Trials Registry (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases.

SELECTION CRITERIA

Randomised controlled trials of orthodontic treatments to correct prominent upper front teeth (Class II malocclusion) in children and adolescents. We included trials that compared early treatment in children (two-phase) with any type of orthodontic braces (removable, fixed, functional) or head-braces versus late treatment in adolescents (one-phase) with any type of orthodontic braces or head-braces, and trials that compared any type of orthodontic braces or head-braces versus no treatment or another type of orthodontic brace or appliance (where treatment started at a similar age in the intervention groups).We excluded trials involving participants with a cleft lip or palate, or other craniofacial deformity/syndrome, and trials that recruited patients who had previously received surgical treatment for their Class II malocclusion.

DATA COLLECTION AND ANALYSIS

Review authors screened the search results, extracted data and assessed risk of bias independently. We used odds ratios (ORs) and 95% confidence intervals (CIs) for dichotomous outcomes, and mean differences (MDs) and 95% CIs for continuous outcomes. We used the fixed-effect model for meta-analyses including two or three studies and the random-effects model for more than three studies.

MAIN RESULTS

We included 27 RCTs based on data from 1251 participants.Three trials compared early treatment with a functional appliance versus late treatment for overjet, ANB and incisal trauma. After phase one of early treatment (i.e. before the other group had received any intervention), there was a reduction in overjet and ANB reduction favouring treatment with a functional appliance; however, when both groups had completed treatment, there was no difference between groups in final overjet (MD 0.21, 95% CI -0.10 to 0.51, P = 0.18; 343 participants) (low-quality evidence) or ANB (MD -0.02, 95% CI -0.47 to 0.43; 347 participants) (moderate-quality evidence). Early treatment with functional appliances reduced the incidence of incisal trauma compared to late treatment (OR 0.56, 95% CI 0.33 to 0.95; 332 participants) (moderate-quality evidence). The difference in the incidence of incisal trauma was clinically important with 30% (51/171) of participants reporting new trauma in the late treatment group compared to only 19% (31/161) of participants who had received early treatment.Two trials compared early treatment using headgear versus late treatment. After phase one of early treatment, headgear had reduced overjet and ANB; however, when both groups had completed treatment, there was no evidence of a difference between groups in overjet (MD -0.22, 95% CI -0.56 to 0.12; 238 participants) (low-quality evidence) or ANB (MD -0.27, 95% CI -0.80 to 0.26; 231 participants) (low-quality evidence). Early (two-phase) treatment with headgear reduced the incidence of incisal trauma (OR 0.45, 95% CI 0.25 to 0.80; 237 participants) (low-quality evidence), with almost half the incidence of new incisal trauma (24/117) compared to the late treatment group (44/120).Seven trials compared late treatment with functional appliances versus no treatment. There was a reduction in final overjet with both fixed functional appliances (MD -5.46 mm, 95% CI -6.63 to -4.28; 2 trials, 61 participants) and removable functional appliances (MD -4.62, 95% CI -5.33 to -3.92; 3 trials, 122 participants) (low-quality evidence). There was no evidence of a difference in final ANB between fixed functional appliances and no treatment (MD -0.53°, 95% CI -1.27 to -0.22; 3 trials, 89 participants) (low-quality evidence), but removable functional appliances seemed to reduce ANB compared to no treatment (MD -2.37°, 95% CI -3.01 to -1.74; 2 trials, 99 participants) (low-quality evidence).Six trials compared orthodontic treatment for adolescents with Twin Block versus other appliances and found no difference in overjet (0.08 mm, 95% CI -0.60 to 0.76; 4 trials, 259 participants) (low-quality evidence). The reduction in ANB favoured treatment with a Twin Block (-0.56°, 95% CI -0.96 to -0.16; 6 trials, 320 participants) (low-quality evidence).Three trials compared orthodontic treatment for adolescents with removable functional appliances versus fixed functional appliances and found a reduction in overjet in favour of fixed appliances (0.74, 95% CI 0.15 to 1.33; two trials, 154 participants) (low-quality evidence), and a reduction in ANB in favour of removable appliances (-1.04°, 95% CI -1.60 to -0.49; 3 trials, 185 participants) (low-quality evidence).

AUTHORS' CONCLUSIONS

Evidence of low to moderate quality suggests that providing early orthodontic treatment for children with prominent upper front teeth is more effective for reducing the incidence of incisal trauma than providing one course of orthodontic treatment in adolescence. There appear to be no other advantages of providing early treatment when compared to late treatment. Low-quality evidence suggests that, compared to no treatment, late treatment in adolescence with functional appliances, is effective for reducing the prominence of upper front teeth.

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.

Severe skeletal Class II Division 1 malocclusion in postpubertal girl treated using Forsus with miniplate anchorage

This case report outlines the treatment of a 17-year-old female with Class II Division 1 malocclusion with mandibular retrusion, deep bite, and convex facial profile. The Forsus fatigue resistance device with miniplate was used for this patient and it was very affecting tool in correcting both skeletal and dental parameters. The total active treatment time was 19 months. This method can serve as an alternate choice of treatment, especially those who refuse orthognathic surgery. Hence, Forsus with miniplate might be useful in both growing and postpubertal patients.

Treatment outcomes of Class II malocclusion cases treated with miniscrew-anchored Forsus Fatigue Resistant Device: A randomized controlled trial

OBJECTIVE

To evaluate the skeletal, dental, and soft tissue effects of the Forsus Fatigue Resistant Device (FRD) used with miniscrew anchorage and compare them with those of the conventional Forsus FRD.

MATERIALS AND METHODS

This study was carried out on 38 patients. These patients were randomly allocated into three groups. The 14 patients in group 1 (aged 12.76 ± 1.0 years) were treated with the FRD appliance. In group 2, the 15 patients (aged 12.52 ± 1.12 years) received treatment with FRD using miniscrew anchorage, and the 9 patients in group 3 (aged 12.82 ± 0.9 years) received no treatment as a control group. Linear and angular measurements were made on lateral cephalograms before and immediately after Forsus treatment. Data were analyzed statistically using paired t-, ANOVA, and Tukey tests.

RESULTS

Class I molar relationship and overjet correction were achieved in both treatment groups. Although mandibular growth was statistically nonsignificant, there was a significant headgear effect on the maxilla. Mandibular incisor proclination, maxillary incisor retroclination, and distalization of maxillary molars were significant in both treatment groups. However, no significant differences were found between the treatment groups.

CONCLUSIONS

Class II correction was mainly dentoalveolar in both treatment groups. Use of miniscrews with Forsus did not enhance mandibular forward growth nor prevent labial tipping of the mandibular incisors.

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.

Assessment of stress changes in dentoalveolar and skeletal structures of the mandible with the miniplate anchored Forsus: A three-dimensional finite element stress analysis study

Objective

The study conducted to assess the effects of a fixed functional appliance (Forsus Fatigue Resistant Device; 3M Unitek, Monrovia, CA, USA) on the mandible with three-dimensional (3D) finite element stress analysis.

Materials and Methods

A 3D finite element model of mandible with miniplate at mandibular symphysis was prepared using SolidEdge software along with the plate geometry. The changes were deliberated with the finite element method, in the form of highest von Mises stress and maximum principal stress regions.

Results

More areas of stress were seen in the model of the mandible at cortical bone in canine region at bone and miniplate interface.

Conclusions

This fixed functional appliance studied by finite element model analysis caused more von Mises stress and principal stress in both the cortical bone and the condylar region.

Treatment of class ii in adulthood by forsus frd device

OBJECTIVES

Scientific research data show that the Forsus FRD seems to have a great potential in the correction of Class II in childhood. The conclusions reached by the various Authors seem to support the hypothesis of an exclusively or mainly dentoalveolar correction, as the skeletal correction seems to have no - or little - appreciable results. In the light of such provided by different Authors, the potential of dentoalveolar compensation in adult patients with mild skeletal class II was investigated.

MATERIALS AND METHODS

At the UOC (Complex Operative Unit) of Orthodontics at "G. Eastman" Hospital Rome, 3 cases of skeletal class II mild (ANB <5 °) in adult patients were selected. They were treated with fixed multibracket appliance and Forsus EZ2 module. Cephalometric tracings were compared at the beginning and at the end of the treatment in order to assess the skeletal and dentoalveolar changes.

RESULTS

The occlusal correction was achieved through a dentoalveolar compensation characterized by the flaring of the lower teeth.

CONCLUSIONS

Forsus FRD equipment is an excellent compromise for the correction of mild Class II, even during the post development age. The resulting correction is appreciated at dental alveolar level with a mesial movement of the incisors and molars.

Dentoskeletal effects produced by a Jasper Jumper with an anterior bite plane

OBJECTIVE

The aim of this retrospective study was to evaluate the dentoskeletal effects produced by a modified Jasper Jumper with an anterior bite plane for the correction of Class II division 1 malocclusion.

MATERIALS AND METHODS

A sample of 32 growing patients (mean age  =  11.9 ± 1.4 years) with Class II division 1 malocclusion and increased overbite were treated with a modified Jasper Jumper (JJ) and anterior bite plane protocol and compared with a matched control group of 30 subjects with untreated Class II malocclusion (mean age 12.2 ± 0.8 years). Lateral cephalograms were taken before treatment (T1) and at the end of comprehensive treatment (T2). Mean treatment duration was 2.1 ± 0.4 years. The T1-T2 changes in the two groups were compared with Student's t-tests for independent samples.

RESULTS

The JJ group was successfully treated to a Class I occlusal relationship with a significant reduction in overjet (-3.9 mm, P < .001) and overbite (-3.1 mm, P < .001). The JJ group exhibited a significant increase in mandibular length and a significant improvement in maxillomandibular sagittal skeletal relationships. The lower incisors were significantly proclined, while the lower first molars demonstrated significant movement in a mesial direction.

CONCLUSIONS

Use of a modified JJ appliance and anterior bite plane is an effective protocol for the treatment of Class II malocclusion with increased overbite and greater skeletal (75%) than dentoalveolar (25%) effects mainly at the mandibular level.

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.

Comparison of patient acceptance of the Forsus Fatigue Resistant Device with and without mini-implant anchorage: a randomized controlled trial

INTRODUCTION

The objective of this 2-arm parallel randomized controlled trial was to evaluate patient acceptance of the mini-implant anchored Forsus Fatigue Resistant Device (FFRD) (3M Unitek, Monrovia, Calif).

METHODS

The study included 32 skeletal Class II girls. The eligibility criteria included a deficient mandible, a horizontal or neutral growth pattern, an increased overjet, and a full set of erupted permanent teeth. After the leveling and alignment stage, FFRDs and mini-implants were inserted; they were removed after the teeth reached an edge-to-edge incisor relationship. The patients were afterward asked to fill out assessment questionnaires regarding their experience with the FFRD.

OUTCOMES

The primary outcome of this study was to assess patient acceptance of the appliance and satisfaction with the results. The secondary outcomes were interference with functional activities, noticeability by others, pain, swelling, gum problems caused by the appliance, and appliance breakage.

RANDOMIZATION

Computer random sequence generation was done using block sizes of 6 and 4. Allocation concealment was achieved with sequentially numbered opaque sealed envelopes.

BLINDING

Blinding of the clinicians and the patients to the intervention was impossible, but it was done for the outcome assessment and the statistician.

RESULTS

The 32 patients were randomly allocated in a 1:1 ratio into 2 groups: 16 patients (mean age, 13.25 ± 1.12 years) received the FFRD alone (FFRD group), and 16 patients (mean age, 13.07 ± 1.41 years) had mini-implants in conjunction with FFRDs (FMI group). No statistically significant differences were reported between the 2 groups regarding ease of appliance insertion, noticeability by others, pain, swelling, effects on eating and speech, and gum bleeding; 100% and 87.5% were satisfied with the results in the FFRD and FMI groups, respectively, with a ridit value of 0.57 (95% confidence interval, 0.43-0.71; P = 0.36). No serious harm was observed other than swelling of the cheeks, which occurred in 4 patients.

CONCLUSIONS

There were no significant differences between the patients' acceptance of the FFRD and the mini-implant anchored FFRD. They were highly satisfied with the results. Neither group reported significant functional limitations.

REGISTRATION

This trial was not registered.

PROTOCOL

The protocol was not published before trial commencement.

FUNDING

The study was self-funded by the authors.

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 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.

Treatment effects produced by the Twin-block appliance vs the Forsus Fatigue Resistant Device in growing Class II patients

OBJECTIVE

To compare the dentoskeletal changes produced by the Twin-block appliance (TB) followed by fixed appliances vs the Forsus Fatigue Resistant Device (FRD) in combination with fixed appliances in growing patients having Class II division 1 malocclusion.

MATERIALS AND METHODS

Twenty-eight Class II patients (19 females and 9 males; mean age, 12.4 years) treated consecutively with the TB followed by fixed appliances were compared with a group of 36 patients (16 females and 20 males; mean age, 12.3 years) treated consecutively with the FRD in combination with fixed appliances and with a sample of 27 subjects having untreated Class II malocclusion (13 females and 14 males; mean age, 12.2 years). Mean observation interval was 2.3 years in all groups. Cephalometric changes were compared among the three groups by means of ANOVA and Tukey's post hoc tests.

RESULTS

The FRD produced a significant restraint of the maxilla compared with the TB and control samples (SNA, -1.1° and -1.8°, respectively). The TB sample exhibited significantly greater mandibular advancement and greater increments in total mandibular length than either the FRD or control groups (SNB, 1.9° and 1.5°, respectively; and Co-Gn, 2.0 mm and 3.4 mm, respectively). The FRD produced a significantly greater amount of proclination of the mandibular incisors than what occurred with the TB or the control samples (2.9° and 5.6°, respectively).

CONCLUSION

The TB appliance produced greater skeletal effects in terms of mandibular advancement and growth stimulation while the Forsus caused significant proclination of the mandibular incisors.

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.

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.

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.