Patient experiences with the Forsus Fatigue Resistant Device

Mandibular molar protraction: A comparison between fixed functional appliances and temporary anchorage devices

INTRODUCTION

This study aimed to compare the efficiency of temporary anchorage devices (TADs) and fixed functional appliances (FFAs) for mandibular molar protraction.

METHODS

Orthodontic records of 1050 consecutively treated patients with molar protraction were screened. Thirty-six records (22 females and 14 males; mean age, 17.4 years) were divided into two groups: TAD (21 subjects with 25 edentulous spaces) and FFA (15 subjects with 24 edentulous spaces). The primary outcome measure was the efficiency of protraction [magnitude and time required for protraction (rate) and anchor loss (AL)]. The secondary outcomes involved measuring the type of tooth movement (TOTM), external apical root resorption (EARR), alveolar bone height change (ABHC), alveolar bone width change (ABWC) and appliance failure.

RESULTS

The rate of tooth movement was significantly higher for FFAs (0.83 ± 0.35 mm/month) versus TADs (0.49 ± 0.2 mm/month) (P = .005). Total treatment duration was less for FFAs (34.78 ± 8.1 months) versus TADs (47.72 ± 13.94 months) (P = .002). TOTM was similar for both (P = .909). EARR was 1.42 ± 1.38 mm for TAD and 1.25 ± 0.88 mm for FFA (P = .81). ABHC increased in the FFA group (1.01 ± 3.62 mm) and decreased for the TAD group (0.68 ± 1.66 mm). ABWC increased for both TAD (1.81 ± 1.73 mm) and FFA (1.75 ± 1.35 mm). The failure rate was 50% for FFAs and 33% for TADs.

CONCLUSIONS

Both systems provided translation of lower molars with comparable anchorage control. However, FFAs were more efficient than TADs for lower molar protraction.

Molar Distalization by Clear Aligners with Sequential Distalization Protocol: A Systematic Review and Meta-Analysis

INTRODUCTION

With the popularity of clear aligners, the sequential distalization protocol has been more commonly used for molar distalization. However, the amount of molar distalization that can be achieved, as well as the accompanying side effects on the sagittal dimension, are unclear.

METHODS

Registered with PROSPERO (CRD42023447211), relevant original studies were screened from seven databases (MEDLINE [PubMed], EBSCOhost, Web of Science, Elsevier [SCOPUS], Cochrane, LILACS [Latin American and Caribbean Health Sciences Literature], and Google Scholar) supplemented by a manual search of the references of the full-reading manuscripts by two investigators independently. A risk of bias assessment was conducted, relevant data were extracted, and meta-analysis was performed using RStudio.

RESULTS

After the screening, 13 articles (11 involving maxillary distalization, two involving mandibular distalization) met the inclusion criteria. All studies had a high or medium risk of bias. The meta-analysis revealed that the maxillary first molar (U6) mesiobuccal cusp was distalized 2.07 mm [1.38 mm, 2.77 mm] based on the post-distalization dental model superimposition, and the U6 crown was distalized 2.00 mm [0.77 mm, 3.24 mm] based on the post-treatment lateral cephalometric evaluation. However, the U6 mesiobuccal root showed less distalization of 1.13 mm [-1.34 mm, 3.60 mm], indicating crown distal tipping, which was validated by meta-analysis (U6-PP angle: 2.19° [1.06°, 3.33°]). In addition, intra-arch anchorage loss was observed at the post-distalization time point (U1 protrusion: 0.39 mm [0.27 mm, 0.51 mm]), which was corrected at the post-treatment time point (incisal edge-PTV distance: -1.50 mm [-2.61 mm, -0.39 mm]).

CONCLUSION

About 2 mm maxillary molar distalization can be achieved with the sequential distalization protocol, accompanied by slight molar crown distal tipping. Additional studies on this topic are needed due to the high risk of bias in currently available studies.

THE USE OF DENTAL PATIENT-REPORTED OUTCOMES AMONG COMPARATIVE OBSERVATIONAL STUDIES IN ORTHODONTICS: A METHODOLOGICAL STUDY

OBJECTIVE

To identify and summarize the presence and characteristics of dental patient-reported outcomes (dPROs) and dental patient-reported outcome measures (dPROMs) within comparative observational studies published in 5 leading orthodontic journals.

METHODS

Electronic searching was performed to identify intervention (therapeutic or preventive) related comparative observational studies published in selected journals between 2015 and 2021. Two authors extracted the characteristics of each included study independently and in duplicate and summarized the dPROs and dPROMs used in these studies. All dPROs were classified into 2 general types (oral health-related quality of life [OHRQoL] and others), while dPROMs were divided into 3 categories (single-item questionnaires, generic multiple-item questionnaires, and specific multiple-item questionnaires). In addition, dPROMs were examined, if they evaluated the 4 dimensions of OHRQoL (oral function, orofacial pain, orofacial appearance, and psychosocial impact).

RESULTS

A total of 683 observational studies were eligible and included of which 117 (17.1%) used dPROs and dPROMs. Seven different dPROs (OHRQoL, patients' satisfaction with treatment, preferences, concerns, compliance, duration, and unwanted events) and 33 different dPROMs (including 8 single-item questionnaires, 11 generic multiple-item questionnaires, and 14 specific multiple-item questionnaires) were identified in these studies. OHRQoL was the most commonly used dPRO (92/117, 78.6%), while Oral Health Impact Profile 14 (OHIP-14) was the most frequently used dPROM (20/92, 21.7%). In terms of study design, cross-sectional studies had the highest proportion of dPRO usage (62/148, 41.9%), followed by cohort studies (63/505, 12.5%) and case-control studies (1/30, 3.3%).

CONCLUSIONS

Only one-sixth of comparative observational studies published in leading orthodontic journals could reflect patients' perspectives. Observational studies in orthodontics need to provide more patient-important information through the use of dPROs and dPROMs.

A Comparative Assessment of Acceptance of Different Types of Functional Appliances

Background Modern clinical orthodontics' functional appliances, a well-established modality of treatment, exhibit an amazing diversity of design. Clinical findings show that people have difficulty adjusting to these devices due to their size and unfixed positioning inside the mouth and that patient adaptation may vary based on the type of orthodontic functional appliance employed. Despite the fact that they appear to inflict more pain and soreness than, for example, removable plates, the effects of various orthodontic functional appliances on patients' acclimation have not yet been researched. Aim The current study's goal was to assess how different functional appliances' shapes and designs affected patients' willingness to accept them. Materials and methods About 20 adult volunteers (10 males and 10 females, age 18-32 years) with marked Class II division 1 malocclusion and not familiar with orthodontic appliances were selected as test subjects. Impressions for working casts were taken, and construction bites were prepared for the fabrication of eight functional appliances of various designs for each individual test subject. These appliances had eight design variations. There were three tests: one for speech effects, one for initial acceptance, and one for final acceptance after wearing different scales. Results Overall, the correlation between the quality of speech and pronunciation after wearing the appliance and the type of functional appliance was statistically significant. The quality of speech and pronunciation after wearing the appliance was maximum in frequency range 1 (FR1), while it was minimum in the medium-size activator. The difference was statistically significant (p=0.001). Overall, the correlation between the comfort and acceptability of functional appliances after wearing them and the type of functional appliance was statistically significant. The acceptance of functional appliances after wearing was maximum in FR1, while it was minimum in the medium-size activator. The difference was statistically significant (p=0.001). Overall, the correlation between the type of functional appliance and initial acceptance was significant statistically, with the maximum initial acceptance in medium-sized activators and the minimum initial acceptance in small bionators (p=0.001). Conclusion The study's findings show that patient acceptance of various kinds of functional appliances varies significantly.

Treatment effects and lip profile changes following premolars extraction treatment vs fixed functional treatment in Class II division 1 malocclusion: A randomized controlled clinical trial

OBJECTIVE

The objective of this two-arm parallel randomized controlled trial was to evaluate the treatment effects and lip profile changes in skeletal Class II patients subjected to premolars extraction treatment versus fixed functional treatment.

METHODS

Forty six subjects fulfilling inclusion criteria were randomly distributed into Group PE (mean age 13.03±1.78 years) and Group FF (mean age 12.80±1.67 years) (n=23 each). Group PE was managed by therapeutic extraction of maxillary first premolars and mandibular second premolars, followed by mini-implant-supported space closure; and Group FF, by fixed functional appliance therapy. Skeletal, dental, and soft-tissue changes were analyzed using pre and post-treatment lateral cephalograms. Data obtained from this open label study was subjected to blind statistical analysis.

RESULTS

Extraction treatment resulted in greater increase of nasolabial angle (NLA: 3.1 [95% CI 2.08, 4.19], p<0.001), significant improvement of upper lip (UL-E line: -2.91 [95% CI -3.54, -2.28], p<0.001, UL-S line: -2.50 [95% CI -2.76, -2.24], p<0.001, UL-SnPog': -2.32 [95% CI -2.90, -1.74], p<0.01) and lower lip position (LL-E line: -0.68 [95% CI -1.36, 0.00], p<0.01, LL-S line: -0.55 [95% CI -1.11, 0.02], p<0.01, and LL-SnPog': -0.64 [95% CI -1.20, -0.07], p<0.01), lip thickness (UL thickness: 2.27 [95% CI 1.79, 2.75], p<0.001; LL thickness: 0.41 [95% CI -0.16, 0.97], p<0.01), upper lip strain (UL strain: -2.68 [95% CI -3.32, -2.04], p<0.001) and soft tissue profile (N'-Sn-Pog': 2.68 [95% CI 1.87, 3.50], p<0.01). No significant difference was observed between the groups regarding skeletal changes in the maxilla and mandible, growth pattern, overjet, overbite, interincisal angle and soft tissue chin position (p>0.05). Premolar extraction treatment demonstrated significant intrusion-retraction of maxillary incisors, better maintenance of maxillary incisor inclination, and significant mandibular molar protraction; whereas functional treatment resulted in retrusive and intrusive effect on maxillary molars, marked proclination of mandibular anterior teeth, and significant extrusion of mandibular molars. Both treatment modalities had similar treatment duration. Implant failure was seen in 7.9% of cases, whereas failure of fixed functional appliance was observed in 9.09% of cases.

CONCLUSIONS

Premolar extraction therapy is a better treatment modality, compared to fixed functional appliance therapy for Class II patients with moderate skeletal discrepancy, increased overjet, protruded maxillary incisors and protruded lips, as it produces better dentoalveolar response and permits greater improvement of the soft tissue profile and lip relationship.

PowerScope 2 functional appliance: A 3D finite element simulation of its action on the mandible

PowerScope 2 is a fixed functional appliance for patients with Class II malocclusion and a retrognathic mandible, that has recently received attention due to its pronounced advantages, for both orthodontists and patients.

Objective

of study: This study evaluated the action of the PowerScope 2 appliance for correcting Class II malocclusion and the stresses and displacement of the mandible during loading using three-dimensional finite element analysis (FEA). The sites of the mandibular skeletal and/or dental corrections were also distinguished.

Materials and methods

Using the AutoCAD (2010) Program, a 3D model of the human mandible with teeth was created based on a CT image of a 20-yr-old patient. Orthodontic stainless-steel brackets with Standard Edgewise (0.022 in) slots bonded to five mandibular teeth and inserted into a bounded tube on the first molar were simulated. A rectangular archwire (0.019 × 0.025 in) ligated the brackets. The created models were uploaded to the Autodesk Inventor Professional Computer Program (FE) version (2020).

Results

The FEA presented the three-dimensional results qualitatively and quantitatively as von Mises stress and displacement. The colour ruler on the upper left side demonstrates the stress and displacement distribution pattern of the mandible, with the minimum value in blue and the maximum value in red. Mandibular movement was achieved three-dimensionally. There was obvious sagittal forward mandibular movement, and high stress was observed at the chin prominence (the pogonion). In the transverse plane, the mandible was highly bent buccally, especially at the gonial angle and antegonial notch. In the vertical plane, the highest ranges of mandibular movements were seen in the chin, the anterior part of the mandibular body, and the associated dentoalveolar region.

Conclusions

The results of this FEA, PowerScope 2 functional appliance proved to be effective as a Class II malocclusion corrector. Its mode of action on the mandible was achieved in three planes of space, and its orthodontic effects were gained dentally and skeletally. An bbvious sagittal forward mandibular movement was observed, particularly at the chin prominence. Apparent buccal bending, especially at the gonial angle and antegonial notch, was observed. Vertically, the chin and anterior part of the mandible, with the associated dentoalveolar structures, were clearly stressed under the action of this appliance.

THE USE OF DENTAL PATIENT-REPORTED OUTCOMES AMONG RANDOMIZED CONTROLLED TRIALS IN ORTHODONTICS: A METHODOLOGICAL STUDY

OBJECTIVE

To identify and summarize the use and characteristics of dental patient-reported outcomes (dPROs) and dental patient-reported outcome measures (dPROMs) within randomized controlled trials (RCTs) published in 5 leading orthodontic journals.

METHODS

A manual search was conducted to identify intervention (therapeutic or preventive) related RCTs published in selected journals between 2015 and 2021. Two authors extracted the characteristics of each included trial, as well as all outcomes and outcome measures used in these trials independently and in duplicate. Thereafter, the use of dPROs and dPROMs was identified and summarized. We classified all dPROs into 2 general types (oral health-related quality of life [OHRQoL] and others) and dPROMs into 3 categories (single-item questionnaires, generic multiple-item questionnaires, and specific multiple-item questionnaires). We also identified whether these dPROMs assessed 4 dimensions of OHRQoL (Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact).

RESULTS

From 4631 examined articles, a total of 315 RCTs were included, of which 76 (24.1%) used dPROs and dPROMs. Eight different dPROs (OHRQoL, patients' satisfaction with treatment, difficulty, compliance, preference, efficacy, duration, and unwanted events) and 34 different dPROMs (including 13 single-item questionnaires, 7 generic multiple-item questionnaires, and 14 specific multiple-item questionnaires) were identified in these trials. OHRQoL was the most commonly used dPRO (n = 71; 93.4%), followed by patients' satisfaction with treatment (n = 10; 13.2%), patient-reported difficulty (n = 5; 6.6%), and patient-reported compliance (n = 4, 5.3%). The 4 most frequently used dPROMs were pain measured with 10 mm Visual Analogue Scale (n = 20; 24.1%), pain measured with Numerical Rating Scale (n = 11; 13.3%), the Feldmann's Questionnaire (2007) (n = 6; 7.2%), and the Oral Health Impact Profile 14 (n = 5; 6.0%).

CONCLUSION

Only about one-fourth of RCTs published in leading orthodontic journals can reflect patients' perspectives. OHRQoL was the most commonly used dPRO in these trials. Substantial heterogeneity exists among dPROMs used for OHRQoL assessment. Efforts are needed from researchers, reviewers, editors and other stakeholders to promote the wide and standardized use of dPROs in orthodontic research.

Evaluation of external apical root resorption caused by fixed functional treatment of class II malocclusion : Cast splint Herbst appliance vs. Forsus fatigue resistant device

INTRODUCTION

The aim of this study was to evaluate and compare the effects of class II fixed functional treatment with a cast splint Herbst appliance (HA; Herbst Set I, Dentaurum, Ispringen, Germany) and Forsus fatigue resistant device (FRD; 3M Unitek Corp., Monrovia, CA, USA) on external apical root resorption (EARR) in posterior teeth.

METHODS

In all, 40 patients (15 male and 25 female) with class II division 1 malocclusion were treated with two fixed functional appliances: HA (20 patients, mean age 14.60 ± 1.14 years) and FRD (20 patients, mean age 14.15 ± 1.28 years). The vestibular lengths of the first molars and premolars were measured on panoramic radiographs and converted to actual tooth length using the magnification coefficient (MC), which was calculated using dental models. Intragroup comparisons of pre- and posttreatment tooth lengths were performed with the paired t‑test and Wilcoxon signed-rank test, while intergroup comparisons were performed with the Mann-Whitney U test.

RESULTS

Pretreatment tooth length values decreased significantly with HA and FRD therapies for all posterior teeth. The maximum resorption was observed in the mandibular first premolar with a mean of 0.81 mm following HA and 1.55 mm following FRD treatment. While no significant difference existed between the EARR values of the HA and FRD groups for maxillary teeth, the amount of EARR of mandibular posterior teeth in the FRD group was significantly higher than in the HA group.

CONCLUSIONS

In patients treated with HA or FRD, the tooth length of posterior teeth decreased to a clinically minor but statistically significant degree. The root resorption effect of FRD therapy in mandibular posterior teeth was significantly higher than that of HA therapy.

Sabit fonksiyonel aygıtların bireylerin ağzıyla ilgili yaşam kalitesine etkisi

Objective: To determine treatment expectations of patients and parents, and the initial effects of fixed functional devices on oral health-related quality of life. Materials and Method: The study comprised 50 patients (39 female, 11 male, mean age 16.24 years) with Angle Class II,1 malocclusion, who were planned to be treated with forsus fatigue resistant device (FFRD). Treatment expectations of the patients and their parents/legal guardians were assessed before the treatment. The Oral Health Impact Profile (OHIP-14) was assessed 1-month after bonding (T1), and repeated 1-month after placement of FFRD (T2). Statistical analysis included Wilcoxon Signed Rank test for the evaluation of the differences in scores between treatment periods and Mann-Whitney U test for the evaluation of gender differences. Results: Main motivation for seeking orthodontic treatment was to improve dental appearance for the patients, and facial esthetics for their parents. Results declared that girls took their orthodontic problems more seriously than boys (p&lt;0.05). The highest mean scores in OHIP-14 were achieved for “difficulty in eating”, and “feeling pain”. No significant difference between treatment periods was noted. Conclusion: This study highlighted the lack of serious adverse effects of the use of fixed functional devices on patients’ quality of life, and that patients might probably experience problems about physical status, mainly for functional limitations, rather than psychological status and social interactions. The findings may assist clinicians in understanding the concerns about these appliances.

A Simple Technique Using a Modified Nance Appliance as Anchorage for Maxillary Molar Distalization—Two Case Reports

Maxillary molar distalization to correct a dental Class II molar relationship and to create space to relieve crowding has been a long-lasting subject of debate in orthodontics. Generally, to distalize maxillary molars, an intra-arch distalization appliance is favored over an inter-arch appliance since it does not utilize mandibular dentition as an anchorage, so some unwanted side effects on mandibular incisors can be avoided. A variety of intra-arch appliances have been developed to distalize maxillary molars, such as the pendulum, Jones jig, first class appliance, distal jet, and modified C-palatal plate. Although they could achieve efficient molar distalization, the learning curve of proper appliance insertion and activation is relatively long. In addition, the appliances are not comfortable for the patients due to the bulky activation units, especially when the activation units are designed in the palatal area. The current manuscript describes a novel and effective maxillary intra-arch molar distalization appliance—a modified Nance appliance technique, which consists of: (1) palatally, a big acrylic button against the palatal rugae and connected to the premolars with wide mesh pads; (2) buccally, regular brackets on maxillary premolars and first molars with sectional round stainless steel archwires and open coil springs between the second premolar and first molar. Either bilateral or unilateral maxillary molar distalization can be achieved with this appliance, and the Class II elastics are not needed. It is simple to be fabricated, delivered, and activated, and it is comfortable for patients.

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.

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.

Investigation and comparison of patient experiences with removable functional appliances

OBJECTIVES

To compare patients' experiences with the Invisalign Teen with Mandibular Advancement® (ITMA) and Twin Block (TB) appliances, both initially and after several months of wear.

MATERIALS AND METHODS

Sixty-eight patients completed an anonymous survey after at least 2 months of wearing ITMA or TB. Forty-five patients treated with ITMA (18 boys, 27 girls, mean age 13.6 years, SD ± 1.54) and 23 patients treated with TB (13 boys, 10 girls, mean age 10.60 years, SD ± 1.92) were included.

RESULTS

More patients using the TB found their appliance to be visually intimidating as compared with patients using the ITMA (21.7% vs 8.9%). TB was more noticeable than the ITMA (69.6% vs 25%). Appliance insertion was more difficult for TB patients (21.8% vs 4.44% for ITMA). After several months, there were more reports of tooth soreness and lip/cheek soreness in the ITMA group. TB patients were more embarrassed even after several months (14.3% vs 0% for ITMA). More TB patients required extra appointments for breakage (50% vs 22.2% for ITMA). Speech, drooling, and jaw and lip/cheek soreness worsened initially for both groups but improved over time. There were no differences between the groups regarding visible facial changes, satisfaction with treatment experience, or time to acclimatize to the appliance.

CONCLUSIONS

TB and ITMA patients shared similar experiences for most of the parameters measured, but there were significant differences between the groups regarding appliance wear and management, discomfort, and function.

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.

Esthetic perception of facial profile changes in Class II patients treated with Herbst or Forsus appliances

OBJECTIVE

To evaluate the esthetic perceptions of orthodontists and laypersons for facial profile changes after orthodontic treatment using Herbst or Forsus appliances.

MATERIALS AND METHODS

Pre- and posttreatment facial profile contour images of 20 Class II patients treated with Herbst (group H; n = 10) and Forsus (group F; n = 10) appliances were analyzed by 30 orthodontists and 30 laypersons, who graded them from 1 (unattractive) to 10 (very attractive) using a visual analog scale. Two assessments were carried out with a 15 day-interval. In the first evaluation, 40 images were presented in a random sequence. In the second evaluation, initial and final facial profile images of each patient were randomly presented side by side. To compare groups in relation to treatment method, Mann-Whitney tests were used. To evaluate differences between time points, Wilcoxon tests were used.

RESULTS

In the first evaluation, there was a significant difference between initial and final images only for group H, for both laypersons (P = .017) and orthodontists (P = .037). There was also a significant difference between laypersons and orthodontists in their ratings of posttreatment Herbst appliance profiles (P = .028). There was no significant difference between initial and final facial profile images for group F and no significant differences between or within evaluator groups in their ratings of initial or final Forsus appliance profiles. In the second evaluation, there was a significant difference between appliance groups only for laypersons, who considered cases treated with the Herbst appliance more attractive than those treated with the Forsus (P = .031). Laypersons also considered Herbst profiles more attractive than did orthodontists (P = .047).

CONCLUSIONS

Class II malocclusion treatment using the Herbst appliance may produce a more esthetically improved facial profile silhouette compared with Forsus appliances. The magnitude of perceived changes may not be considered clinically relevant.

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.

Dentoskeletal Class II Malocclusion: Maxillary Molar Distalization with No-Compliance Fixed Orthodontic Equipment

Dentoskeletal class II malocclusion due to a protruded upper dental arch is a major reason for an orthodontic treatment. In these cases, the correction of class II can be hindered by molar distalization, obtained with 'no-compliance therapy' that involves the use of appliances which minimize the need for such co-operation and attempt to maximize the predictability of results. The aim of this review was to outline the effectiveness of no-compliance fixed orthodontic devices in the molar distalization. After selection according to the inclusion/exclusion criteria, 16 articles from 2000 to 2019 were qualified for the final analysis. The literature shows various no-compliance fixed devices whose effect is to distalize the maxillary molars. The present revision allows to conclude that there is a need to increase the number of studies, especially with regard to the most recently introduced devices in the literature. The analysed studies allow to hypothesize that these appliances act with a minimal variability of molar distalization and disto-inclination among them, although different effects among the appliances can be observed as regards to the anchorage.

Treatment of a Class II Division 1 malocclusion with the combination of a myofunctional trainer and fixed appliances

This case report describes the combined use of a myofunctional Trainer for Braces and fixed appliances to treat a 10-year-old girl with a Class II Division 1 malocclusion that featured severe maxillary incisor protrusion, a large overjet, and a V-shaped maxillary arch. She had a convex profile with an underdeveloped mandible. The superiority of myofunctional training in the case was to eliminate mouth breathing and lip sucking habits, train the oral musculature, stimulate mandibular growth, and make braces work more efficiently. The posttreatment facial photographs show improvement in the facial profile. Proper occlusion and facial balance were created, which were quite stable as demonstrated by the patient's 4-year follow-up records.

Additional appointments and discomfort associated with compliance-free fixed Class II corrector treatment: a systematic review

OBJECTIVE

A critical analysis of the literature to determine the prevalence and type of emergency/additional appointments, and discomfort levels associated with fixed Class II correctors.

METHODS

Studies examining patient's sources of discomfort or emergency appointments associated with compliance-free Class II correctors were included. Comprehensive searches up to July 2018 were conducted using the following databases: MEDLINE (OvidSP), PubMed, Web of Science, and Embase. A partial grey literature search was taken using Google Scholar and OpenGrey. Two reviewers independently performed the selection process and risk of bias assessment. The Newcastle-Ottawa Scale for cross-sectional studies were used. A summary of the overall strength of evidence was presented using 'Grading of Recommendations, Assessment, Development and Evaluation' (GRADE) tool. Included studies were evaluated according to their design, study quality, consistency, and directness.

RESULTS

The selected studies were published between 2001 and 2018, and the number of patients per studied group ranged from 8 to 182. One thousand five hundred forty-two patients were evaluated in total. The patients' mean age at start of treatment ranged from 10 to 16.9 years and the fixed Class II corrector treatment duration ranged from 4 to 12 months. The included studies in this systematic review were too clinically heterogeneous (different appliances, different data recollection processes) to justify a meta-analysis.

LIMITATIONS

This review was not previously registered. A low level of evidence was observed among the two randomized trials, the 10 cohorts and three cross-sectional studies identified.

CONCLUSIONS

The main source of discomfort from Forsus-type appliances appears to be soreness in the cheeks (low level of evidence with a weak recommendation strength). Most evaluated patients treated with a Herbst appliance, regardless of design, will experience complications (fractures and/or dislodging) requiring emergency appointments (low level of evidence with a weak recommendation strength).

REGISTRATION

The review protocol was not registered.

Twenty-year clinical experience with fixed functional appliances

Introduction:

Considering the large number of fixed functional appliances, choosing the best device for your patient is not an easy task.

Objective:

To describe the development of fixed functional appliances as well as our 20-year experience working with them.

Methods:

Fixed functional appliances are grouped into flexible, rigid and hybrid. They are different appliances, whose action is described here. Four clinical cases will be reported with a view to illustrating the different appliances.

Conclusions:

Rigid fixed functional appliances provide better skeletal results than flexible and hybrid ones. Flexible and hybrid appliances have similar effects to those produced by Class II elastics. They ultimately correct Class II with dentoalveolar changes. From a biomechanical standpoint, fixed functional appliances are more recommended to treat Class II in dolichofacial patients, in comparison to Class II elastics.

Comparative evaluation of treatment effects between two fixed functional appliances for correction of Class II malocclusion: A single-center, randomized controlled trial

OBJECTIVE

The objective of this study was to evaluate and compare the effects of PowerScope and Forsus in the treatment of Class II division 1 malocclusion.

MATERIALS AND METHODS

This was a 2-arm parallel, double-blind, randomized, controlled trial. A total of 28 Class II division 1 malocclusion patients indicated for treatment with fixed functional appliances were randomized and equally divided (n = 14) among PowerScope (American Orthodontics, Sheboygan, Wis; mean age 14.11 ± 1.3 years) and Forsus (3M Unitek Corp, Monrovia, Calif; mean age 15.5 ± 1.1 years) groups. Skeletal and dentoalveolar effects of PowerScope and Forsus were compared. The secondary outcomes were evaluation of patient comfort and operator convenience. Randomization was accomplished with a 1:1 allocation ratio, and concealment was achieved by sealed opaque envelopes. The participants and data collectors were all blinded to study group allocation. Data were analyzed for 26 patients, 13 in each group, as one patient from each group discontinued treatment. Statistical comparisons were carried out using Student's t-tests and chi square tests ( P ≤ .05).

RESULTS

A significantly greater mesial mandibular movement and improvement in sagittal skeletal relation were found in the Forsus patients ( P ≤ .05). The forward movement of the mandibular molar and incisors were greater in the PowerScope patients (2.3 mm and 2.80 mm) than in the Forsus patients (1.9 mm and 2.38 mm).

CONCLUSIONS

Both PowerScope and Forsus are effective in correcting Class II malocclusion. The percentage of dentoalveolar effects in correcting Class II malocclusion is more for PowerScope when compared with Forsus. Patient comfort was the same with both appliances. This trial was registered.

Patients' and Parents' Perception of Functional Appliances: A Survey Study

OBJECTIVE

To evaluate patients' and parents' perception of removable, fixed rigid, and fixed hybrid functional appliances and to compare their impacts on anxiety and discomfort during treatment in different age groups and genders.

METHODS

Data were gathered by means of a questionnaire that included items presumed to be associated with orthodontic compliance. A self-administered questionnaire was used to quantify patients' and parents' perceptions. Three groups were formed regarding the type of functional appliance used: fixed rigid (Functional Mandibular Advancer, FMA), fixed hybrid (Forsus Fatigue Resistant Device, FRD), and removable (Twin Block, TB). Two separate questionnaires were used for the patients and their parents comprising the necessary context. Chi-square, Mann-Whitney U, and Kruskal-Wallis tests were used for data analysis.

RESULTS

Patients needed less time to adapt to the FRD appliance. Eating difficulties were encountered by patients in the FMA group. Adolescents who had completed functional orthodontic treatment with a removable appliance had difficulties in controlling their saliva. Patients' and parents' perceptions were found to be in accordance with each other.

CONCLUSION

Adolescents who had completed functional orthodontic treatment with fixed appliances had more difficulty in their daily life. Orthodontists should be aware of this impact caused by functional orthodontic treatment and should regularly encourage patients by reminding them of the improvements to be had by fixing the malocclusion.

En-masse protraction of mandibular posterior teeth into missing mandibular lateral incisor spaces using a fixed functional appliance

Protraction of mandibular posterior teeth requiring absolute anchorage has always been a challenge, especially when the space is located in the anterior region, since more teeth must be protracted. Traditionally, skeletal anchorage devices have been used for anchorage reinforcement during protraction. However, drawbacks such as requirement of a surgical step, inability to tolerate heavy forces, and patient willingness to undergo such surgical procedures can be limiting factors. Additionally, the mechanics involved can sometimes create undesirable side effects, thereby limiting their application in such situations. This report describes the use of a fixed functional appliance as an anchorage-reinforcement device for en-masse protraction of mandibular posterior teeth into a missing lateral incisor space.

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.

Management of Class II malocclusion with ectopic maxillary canines

Correction of Class II relationship, deep bite and ectopically erupting canines is an orthodontic challenge for the clinician. A 13-year-old male patient presented with Class II malocclusion, ectopically erupting canines, and cross bite with maxillary left lateral incisor. He was treated with a combination of Headgear, Forsus™ fatigue resistant device [FFRD] with fixed mechanotherapy for the management of space deficiency and correction of Class II malocclusions. Headgear was used to distalize upper first molars and also to prevent further downward and forward growth of the maxilla. Then Forsus™ FFRD was used for the advancement of the mandible. The molar and canine relationship were corrected from a Class II to a Class I. The objectives were to establish good occlusion and enable eruption of unerupted canines. All these objectives were achieved and remained stable.

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.

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.