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

Evaluation of modified clear Twin Block aligner in treating adolescents with skeletal class II malocclusion: A two-centre cephalometric study

INTRODUCTION

The purpose of this study was to evaluate the therapeutic effect of modified clear Twin Block (CTB) aligner and traditional twin block (TB) appliance from skeletal, dentoalveolar and soft tissue changes in adolescents with skeletal class II malocclusion.

METHODS

A total of 80 adolescents, included in this study from two medical centres, were distributed into CTB group, TB group and control group based on the treatment they received. Lateral cephalograms at pre-treatment (T1) and post-treatment (T2) were measured by modified Pancherz's cephalometric analysis, and dentoskeletal and soft tissue changes were analysed by independent-sample t-test, paired-sample t-test, ANOVA test and Scheffe's Post Hoc test.

RESULTS

Seventy-five adolescents completed the study, including 32 in the CTB group, 32 in the TB group and 11 in the control group. Both CTB and TB treatment showed significant differences in most dentoskeletal and soft tissue measurements. Compared with the control group, improvements were observed in class II molar relationship through significant different in S Vert/Ms-S Vert/Mi in the CTB group (P < .01) and the TB group (P < .001), as well as deep overjet through significant different in S Vert/Is-S Vert/Ii in the CTB group (P < .001) and the TB group (P < .001). Besides, the CTB group also showed less protrusion of lower incisors and resulted in a more significant improvement in profile with fewer adverse effects on speaking, eating and social activities.

CONCLUSIONS

For adolescents with skeletal class II malocclusion, CTB appliance was as effective as TB on improving dentoskeletal and soft tissue measurements, featuring more reliable teeth control and patient acceptance.

Stability of class II correction with the Austro Repositioner associated with multi-brackets fixed appliances in dolichofacial patients

BACKGROUND

The purposes of the present study were to evaluate the changes produced by the Austro Repositioner, and to assess the stability of Class II malocclusion treatment with the Austro Repositioner associated with fixed appliances and its capacity to control the vertical dimension in dolichofacial patients.

METHODS

A group of patients with Class II malocclusion due to mandibular retrognathism and a dolichofacial growth pattern treated with the Austro Repositioner combined with fixed appliances were compared to a matched untreated control group of subjects with Class II malocclusion. Evaluations were made on the basis of lateral cephalograms taken at T1 (initial records), T2 (end of treatment), and T3 (1 year after treatment). Statistical comparisons were performed with paired- and two-sample t tests.

RESULTS

The experimental (treated) group comprised 30 patients, 14 boys and 16 girls, and the control group comprised 30 subjects (15 boys and 15 girls) with similar ages at T1, T2 and T3. In the treated group, a significant decrease in the ANB angle was found (- 3.79 ± 1.46; p < 0.001). No significant differences were found in the maxillary skeletal measurements. In contrast, the SNB angle showed a significant increase of 3.77 ± 1.49 in the treated group compared with a nonsignificant increase of 0.77 ± 1.55 in the control group (p = 0.002). Vertical changes showed a significant decrease in the FMA angle (- 3.36 ± 1.62), while the lower anterior facial height distance and the overbite increased significantly in the treated group, reflecting a change in vertical dimensions after treatment. No significant changes were observed in either the treated or control group during the one-year posttreatment period; thus, the treatment results remained stable.

CONCLUSIONS

The Austro Repositioner combined with fixed appliances could be considered an optimal treatment modality in Class II dolichofacial patients.

Three-dimensional Evaluation of the Carriere Motion 3D Appliance in the treatment of Class II malocclusion

INTRODUCTION

This study aimed to quantify the outcomes of adolescent patients with Class II malocclusion treated with the Carriere Motion 3D Appliance (CMA) combined with full fixed appliances.

METHODS

Cone-beam computed tomography scans of 22 patients were available before orthodontic treatment (T1), at removal of the CMA (T2), and posttreatment (T3). The average age of the patients was 13.5 ± 1.6 years at T1, 14.1 ± 0.2 years at T2, and 15.6 ± 0.5 years at T3. The 3-dimensional image analysis procedures were performed using ITK-SNAP (version 3.6.0; www.itksnap.org, Hatfield, Pa) and SlicerCMF (version 4.11.0; http://www.slicer.org, Cambridge, Mass); skeletal and dentoalveolar changes relative to cranial base, maxillary, and mandibular regional superimpositions were evaluated.

RESULTS

Changes were analyzed with 1 sample t tests using the mean differences during the CMA phase (T1 to T2) and total treatment time (T1 to T3). Significant skeletal changes included a slight reduction of ANB from T1 to T3, mandibular growth (Co-Gn increment of 1.2 mm and 3.3 mm from T1 to T2 and T1 to T3, respectively), inferior displacement of point A, and anterior and inferior displacement of point B. The mandibular plane did not change significantly during treatment. During the CMA treatment, posterior tipping and distal rotation of the maxillary molars, tip back and inferior displacement of the maxillary canines, significant mesial rotation, and superior displacement of the mandibular molars were observed. These movements rebounded during the full fixed appliance phase except for the molar and canine vertical displacements. Clinically significant dental changes during treatment included a reduction in overjet and overbite, Class II correction of the molar and canine relationship, and proclination of the mandibular incisors.

CONCLUSIONS

The CMA is an effective treatment modality for Class II correction in growing patients because of a combination of mesial movement of the mandibular molar, distal rotation of the maxillary molar, and anterior displacement of the mandible.

Twin-block and mandibular anterior repositioning appliances effects in Class II malocclusion correction

INTRODUCTION

The objective of this study was to compare the cephalometric changes in Class II Division 1 malocclusion patients treated with the Twin-block (TB) and the mandibular anterior repositioning appliance (MARA).

METHODS

This retrospective study was performed with 132 lateral cephalograms of patients with Class II malocclusion divided into 3 groups: a TB group comprised 21 patients with mean initial and final ages of 10.59 and 11.97 years, respectively, treated for a mean period of 1.38 years; a MARA group comprised 21 patients with mean initial and final ages of 11.98 and 13.20 years, respectively, treated for a mean period of 1.22 years; and a control group included 24 subjects with untreated Class II malocclusion with mean initial and final ages of 10.55 and 12.01 years, respectively, observed for a mean period of 1.46 years. Cephalometric intergroup comparisons regarding the treatment changes (T2 - T1) were performed with the analysis of covariance, followed by Tukey tests.

RESULTS

Both appliances demonstrated significant restriction of the maxilla and improvement of the maxillomandibular relationship. The MARA produced a significantly greater amount of labial tipping and protrusion of the mandibular incisors than the other groups. The TB showed significant extrusion of the mandibular incisors and molars compared with MARA and control, respectively. Both treated groups reduced the overjet and overbite. The MARA presented a significantly greater reduction in the molar relationship than the other groups.

CONCLUSIONS

The appliances showed a headgear effect on the maxilla and effectively changed Class II cephalometric parameters through a combination of skeletal and dentoalveolar effects. TB showed a greater increase in LAFH. MARA promoted greater labial tipping and protrusion of the mandibular incisors.

Evaluation of Local Application of Glucosamine Sulfate and Chondroitin Sulfate on Temporomandibular Joint Response and Alleviation of Pain and Tension During the Functional Treatment of Skeletal Class II Patients: A Randomized Control Clinical Trial

OBJECTIVE

 This study was conducted to assess the effects of applying a gel of combined glucosamine sulfate and chondroitin sulfate on the temporomandibular joint (TMJ) area in patients with skeletal Class II malocclusion treated by removable functional appliances in terms of TMJ internal proportions, levels of pain, and tension.

MATERIALS AND METHODS

The study included 36 patients aged 10-13 years with skeletal Class II malocclusion due to retrusion of the mandible characterized by: 4-8 degrees of the sagittal skeletal discrepancy (ANB) angle, 4-7 mm of overjet, 72-76 degrees of the sagittal mandibular positioning (SNB) angle, and a bone maturity stage located at pubertal growth spurt. Patients were distributed to the experimental group (Twin-Block appliance + Jointance® gel) or the control group (conventional treatment with the Twin-Block appliance). An allocation ratio of 1:1 was employed. Pre- and post-treatment digital lateral cephalometric radiograms were taken, and the TMJ joint spaces were measured using the Viewbox software (dHAL Software, Kifissia, Greece). The pain and discomfort levels were evaluated using a questionnaire with a four-point Likert scale at three assessment times.

RESULTS

 The anterior and posterior glenoid and anterior condylar distances to the pterygoid vertical (PTV) reference plane significantly decreased after treatment (p<.001), and the anterior joint space decreased significantly (p<.001). In contrast, the superior distance of the condyle to the Frankfort horizontal reference plane increased significantly after treatment, and the same results were found for the posterior and superior joint spaces (p<.05). There were no significant differences between the two groups in the evaluated linear variables. No significant differences were found when comparing pain and tension levels between the two groups at each assessment time. A gradual decrease in pain and tension levels was observed between the three evaluation times in both groups.

CONCLUSIONS

 A combination of glucosamine sulfate and chondroitin sulfate did not affect the temporomandibular joint spaces, pain, and tension levels in patients with skeletal Class II malocclusions treated by removable functional appliances.

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.

Evaluation of the Functional Treatment of Patients With Skeletal Class II Malocclusion Using Low-Level Laser Therapy-Assisted Twin-Block Appliance: A Three-Arm Randomized Controlled Trial

Background

Different techniques have been used to reduce functional treatment time including low-level laser therapy (LLLT), and the majority of studies have been conducted on animals. Therefore, the aim of the current study was to evaluate the effects of LLLT on improving orthodontic functional treatment using the Twin-Block (TB) appliance.

Materials and methods

This study was a three-arm, parallel-group randomized controlled trial. Patients were selected using the following inclusion criteria: skeletal Class II Division 1 malocclusion resulting from mandibular retrognathia (angle between the anterior cranial base and the NB plane (i.e., SNB angle): 73°-78°), the sagittal skeletal discrepancy angle (ANB angle) between 4° and 9°, and overjet between 5 and 9 mm. Forty-eight patients were randomly allocated into three equal groups. In the LLLT-TB group, the low-level laser device was used with a wavelength of 808 nm and power of 250 mW in addition to functional treatment with a Twin-Block appliance. The laser was applied on the skin at the bilateral temporomandibular joint (TMJ) regions, at five points, each point received 5 J of the laser for 20 seconds. The laser course was twice a week in the first month, every two weeks in the second month, and every three weeks up to the end of the treatment. The second group (the TB group) received functional treatment with a Twin-Block appliance, while patients in the third group (the untreated control group (UCG)) were observed for nine months without any intervention.

Results

There were statistically significant differences in treatment periods between the LLLT-TB group and the TB group (129 days and 235 days, respectively, P-value<0.001). The change in the effective mandibular length (Co-Gn) was the highest in the LLLT-TB group compared with the TB and the UCG groups (4.41 mm, 3.66 mm, and 1.07 mm, respectively; P-value<0.001).

Conclusions

The application of low-level laser therapy on the condylar regions accelerated the functional treatment in skeletal Class II malocclusion patients by approximately 45% and increased the bone growth and mandibular length. The improvement in the SNB angle was similar in both interventional groups. Irradiation of low-level laser stimulated bone growth at the condyles and did not cause anterior movement of the temporomandibular joint following functional orthopedic correction.

Skeletal and Dentoalveolar Effects Induced by the Paolone- Kaitsas Appliance in the Treatment of Class II Malocclusion: A Controlled Retrospective Study on Lateral Cephalograms

The aim of this study was to assess the skeletal and dentoalveolar effects induced by the Paolone-Kaitsas functional appliance (PK appliance) in the treatment of growing patients affected by Class II malocclusion. A group of 25 Class II patients, treated with the PK appliance followed by fixed appliances, was evaluated with lateral cephalograms at the start (9.6 ± 1.6 years) and at the end of treatment (13.0 ± 1.5 years), and was compared with a matched untreated Class II control group of 23 subjects selected from the web archive of the American Association of Orthodontists Foundation Craniofacial Growth Legacy. Statistical comparisons were performed with the Student’s t-tests. The treated group showed a significant decrease in SNA (−2.2°), ANB (−2.2°), and Wits appraisal (−3.4 mm), a significant increase in the SN-palatal plane angle (1.1°), and a significant improvement in overjet (−2.9 mm), overbite (−2.5 mm), and molar relationship (3.6 mm). The PK appliance produced favorable dentoalveolar and skeletal effects: it inhibited maxillary growth without effects on the mandible and it also induced a downward inclination of the palatal plane.

Cephalometric analysis of dental and skeletal effects of Carriere Motion 3D appliance for Class II malocclusion

INTRODUCTION

The objective was to describe the dental and skeletal changes obtained using the Carriere Motion Appliance (CMA), lateral cephalogram, and the corresponding cephalometric tracings.

METHODS

A sample of 29 patients with Class II malocclusion (mean age, 12.6 ± 1.7 years) was retrospectively selected. All patients were treated at a single center using a CMA as the primary sagittal correction device. Cephalometric tracings at the beginning and end of treatment were compared. Each cephalometric tracing was performed 3 times by the same operator.

RESULTS

Using the CMA, the 29 patients studied reached dental Class I in 4.4 ± 0.98 months. All measurements were subjected to statistical analysis, paired t test, and all displayed differences between T0 and T1 (P <0.05) except for the SNA. At the end of treatment, the Wits and ANB values were reduced by 1.38 mm and 0.8°, respectively. Overbite and overjet were also reduced by 1.4 mm and 2 mm, respectively. The SNB, FMA, LAFH, and IMPA increased to a lesser extent (ie, 0.7°, 0.4°, 1.5 mm, and 1.5°, respectively).

CONCLUSIONS

The CMA is a rapid and efficient means of correcting Class II malocclusion. Its effects are predominantly dentoalveolar, with minimal skeletal alteration of little clinical significance.

Comparison of AdvanSync2® and Twin Block Appliances in Treatment of Class II Malocclusion With Retrognathic Mandible—An Observational Retrospective Study

Objectives:

To evaluate the treatment outcomes between Twin Block and AdvanSync2® appliances by comparing the skeletal, dentoalveolar, and soft tissue changes.

Materials and Methods:

Radiographic data of 20 patients were retrospectively analyzed. Data were selected from patients in their skeletal growth spurt as evaluated by the cervical vertebral maturation method (CVMI 2, 3, and 4), with class II malocclusion characterized with retrognathic mandible (ANB > 4°, SNB < 77°, FMA = 25 ± 5°, overjet > 5 mm). There were 10 patients in each group that underwent orthodontic correction for class II malocclusion: either using Twin Block or AdvanSync2®. Independent t test and Paired t test and chi-square tests were used for the data analysis. The level of statistical significance was set at P value ≤.05.

Results:

The chronological and skeletal age were similar in both the groups. Records were taken for the functional treatment with mean treatment span of 8 ± 1 month. Changes in SNB (group I = 1.59°, group II = 3.11°) ( P < .01), Co-Gn (group I = 2.89 mm, group II = 5.34 mm), and U1-L1° (group I = −1.51°, group II = 2.97°) showed statistically different outcome between the groups, when the pre-post data were studied. Rest of the variables—cranial base, maxillary skeletal, mandibular skeletal, intermaxillary, vertical skeletal, maxillary dentoalveolar, mandibular dentoalveolar, and soft tissue—showed similar outcome ( P > .05).

Conclusion:

Both appliances lead to desirable outcomes in the correction of class II malocclusion. AdvanSync2® resulted in inducing more of changes in SNB and effective mandibular length as compared to Twin Block. Overjet and molar relation improved significantly with both the appliances. Both the appliances resulted in similar skeletal, dentoalveolar, and soft tissue changes.

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.

Comparison of twin block appliance and Forsus Fatigue Resistant Device therapies on uvulo-glossopharyngeal dimensions: A retrospective study

Objectives:

The aim of this study was to compare the effects of two different functional appliances on skeletal, dental, and uvulo-glossopharyngeal dimensions.

Materials and Methods:

Pre- and post-treatment lateral cephalograms of 50 adolescent Class II patients with a retrognathic mandible were obtained from an archive and divided into two groups according to functional therapy. Twenty-five patients (14 females, 11 males, mean age: 13.5 ± 2.8) who were treated with Forsus Fatigue Resistant Device (FFRD) and 25 patients (17 females, eight males, mean age: 12.5 ± 0.4) who had received functional therapy through the twin block (TWB) were enrolled. Skeletal, dentoalveolar, tongue, uvula, hyoid position, and oropharyngeal airway parameters were measured using the Dolphin software, and uvulo-glossopharyngeal area measurements were performed with the AutoCAD software.

Results:

The TWB group exhibited remarkable mandibular advancement compared to the FFRD group (P < 0.05). Both of the treatments proclined mandibular incisors, and tongue dimensions increased significantly in both groups (P < 0.05). While the hyoid point moved forward and the oropharyngeal area increased significantly in the TWB group, no significant changes were observed in the FFRD group. The comparison of the TWB and FFRD groups with regard to uvulo-glossopharyngeal dimensions showed no significant differences between the groups (P > 0.05).

Conclusion:

Changes in uvulo-glossopharyngeal dimensions did not significantly vary between the two different functional therapies.

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.

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

OBJECTIVES

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

MATERIALS AND METHODS

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

RESULTS

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

CONCLUSIONS

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

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

OBJECTIVES

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

SETTING AND SAMPLE POPULATION

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

MATERIALS AND METHODS

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

RESULTS

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

CONCLUSION

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

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.

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

INTRODUCTION

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Evaluation of Root Resorption, Tooth Inclination and Changes in Supporting Bone in Class II Malocclusion Patients Treated with Forsus Appliance

OBJECTIVE

The aim of our study was to evaluate apical root resorption and changes in tooth inclinations, marginal bone height, and labio-lingual bone thickness at the mid-root and apical level in mandibular anterior teeth during the Forsus treatment using cone beam computed tomography (CBCT).

METHODS

CBCT scans of 16 subjects (8 males and 8 females) with Class II malocclusion (age group: 13-29 years) taken before and 6 months after the Forsus treatment were evaluated for apical root resorption, tooth inclination, marginal bone height, and thickness of bone at the mid-root and apical level in mandibular anterior teeth.

RESULTS

There was statistically significant root resorption of central incisors (0.39 mm) and canines (0.66 mm); a decrease in the angle of inclination for all teeth; an increase in the marginal bone measurement in labial (1.31 mm) and decrease in lingual (0.93 mm) aspect at the canine region; and an increase in bone width by 0.87 mm and 0.75 mm in central and lateral incisor regions, respectively, at the mid-root level lingually. At the apex level in the canine region, bone width increased by 1.4 mm labially, while it decreased by 2.18 mm lingually; it increased significantly for incisors in the lingual region.

CONCLUSION

The Forsus appliance therapy causes clinically insignificant root resorption and bone changes, and clinically significant proclination of mandibular anterior teeth. The findings of the present study aid clinicians in proper case selection and reinforce the prevention of incisor proclination while using the Forsus therapy to achieve better treatment results and stability.

Upper Airway Changes following Functional Treatment with the Headgear Herbst or Headgear Twin Block Appliance Assessed on Lateral Cephalograms and Magnetic Resonance Imaging

OBJECTIVE

The present study compared the changes in the upper airway dimensions and sleep-related breathing disorder (SRBD) condition between functional treatment with the headgear Herbst (HG-Herbst) and headgear Twin Block (HG-TB) appliance. Soft tissues were assessed on lateral cephalometric X-ray and magnetic resonance imaging (MRI).

MATERIALS AND METHODS

Consecutive patients who sought orthodontic treatment at the Faculty of Dentistry of The University of Hong Kong were screened. Adolescents (12-17 year sold for boys and 10-15 years old for girls), with class II molar relationship and overjet >5 mm, with no severe transverse maxillary deficiency, were recruited. Patients were assigned either to the HG-Herbst or to the HG-TB treatment by stratified block randomisation, with sex as the stratification factor. Lateral cephalograms, magnetic resonance imaging (MRI), and the Paediatric Sleep Questionnaire (PSQ) were obtained at baseline and after treatment.

RESULTS

28 patients were enrolled, and 26 patients (13 in each group) completed the treatment. Following 1 year of functional appliance treatment, a significantly lower increase of the lower anterior facial height was observed in the HG-Herbst group compared to the HG-TB group (p = 0.024). However, no significant differences were observed in the upper airway structures or SRBD between the two groups.

CONCLUSION

The changes in upper airway dimensions and SRBD condition were not significantly different between the HG-Herbst and the HG-TB appliance treatment. Additional studies with larger sample size are warranted.

Effects of Low-Intensity Pulsed Ultrasound Therapy on the Temporomandibular Joint Complex in Conjunction With a Fixed Functional Appliance: A Prospective 3-Dimensional Cone Beam Computed Tomographic Study

OBJECTIVES

This prospective study aimed to analyze 3-dimensional changes in the temporomandibular joint (TMJ) complex with a synergistic effect of functional jaw orthopedics using a fixed functional appliance and low-intensity pulsed ultrasound (LIPUS) therapy.

METHODS

Forty patients with skeletal class II malocclusion were randomly assigned to 4 groups (2 control groups and 2 test groups) of 10 patients each. After insertion of the fixed functional appliance, the test group was stimulated with LIPUS therapy in the TMJ region bilaterally for 20 minutes daily for first 10 days and thereafter at least 3 times per week until complete mandibular advancement was achieved. Three-dimensional images obtained with a cone beam computed tomographic scanner were used to analyze the changes in the TMJ complex at the prefunctional stage and after completion of functional appliance therapy. Direct intragroup and intergroup comparisons for different morphometric variables were conducted with the Student t test.

RESULTS

The 40 patients included 20 male and 20 female patients between the ages of 12 and 16 years (mean age ± SD, 13.2 ± 1.8 years). Both the test groups and the control groups showed statistically significant variable changes in condylar head position and morphometric changes in relation to the joint space analysis (mean differences, -1.000 and -1.080 mm; P < .05). However, no significant differences were found during the intergroup comparisons at the prefunctional and postfunctional stages for the variables examined, except for the measurements of the linear distance of the condyle to the external auditory meatus on both the right and left sides at the prefunctional phase.

CONCLUSIONS

Low-intensity pulsed ultrasound therapy positively affects the quantum of the joint space, thus proving to be a promising adjunct in enhancing treatment outcomes of functional jaw orthopedics in growing patients with skeletal class II malocclusions.

Short-term dentoskeletal changes following Class II treatment using a fixed functional appliance: the Austro Repositioner : A pilot study

OBJECTIVE

Purpose of this prospective study was to evaluate the skeletal and dentoalveolar effects of a fixed functional appliance, the Austro Repositioner, in dolicho- and brachyfacial skeletal Class II patients.

MATERIAL AND METHODS

In all, 20 dolicho- and 25 brachyfacial consecutive patients treated with the Austro Repositioner were compared with untreated controls (20 dolicho- and 20 brachyfacial patients) with the same initial dentoskeletal features. Lateral cephalograms were acquired before and 1.0±0.2 year after therapy.

RESULTS

Significant improvements in skeletal Class II relationships were observed in both groups. The ANB angle decreased (3.56° in dolicho- and 3.13° in brachyfacial patients, P < 0.001) due to changes localized exclusively in the mandible, the SNB angle increased to 3.20° in dolicho- and 3.02° in brachyfacial patients, and the total mandibular length (Co-Pg) increased to 6.47 mm in dolicho- and 5.78 mm in brachyfacial patients (P < 0.001). A favorable guidance of vertical pattern was also achieved in both groups, and no significant changes were observed in the upper and lower incisors in both groups.

CONCLUSIONS

The Austro Repositioner was effective for short-term treatment of skeletal Class II malocclusion resulting from the retrusion of the mandible in both dolicho- and brachyfacial patients.

Dentoskeletal and aesthetic effects of mandibular protraction appliance (MPA) using Ricketts analysis

Abstract Objective This study was designed to evaluate the skeletal, dental and soft tissue effects of mandibular deficiency treatment with the mandibular protraction appliance (MPA) using 12 factors of the Ricketts analysis. Material and method This cross-sectional retrospective study sample consisted of a group (n = 27), with Class II malocclusion, convex facial profile, increased horizontal trespass and mandibular deficiency, with initial mean age of 12.27 and final of 15.18 years, treated with fixed appliance combined with the MPA, in an average time of 2.9 years. Initial and final radiographs were investigated using Ricketts analysis. The dependent t-test was used to compare the initial and final phases of the MPA group, with a significance level of 5%. Result Statistically significant differences were observed for dental changes such as retrusion (p=0.000) and palatal inclination of the maxillary incisors (p=0.000); protrusion (p=0.000) and buccal inclination of the mandibular incisors (p=0.000); increased interincisal angle (p=0.002) and improved molar ratio (p=0.003). There was also a restriction of the anterior displacement of the maxilla (p=0.000) and a decrease in the mandibular plane angle (p=0.024). The variable inferior labial protrusion with significance (p=0.000), reiterated the improvement in the profile. Conclusion The effects of MPA on correction of malocclusion Class II, verified by Ricketts analysis occurred predominantly by dentoalveolar changes, decrease in the Mandibular Plane Angle, and restriction of anterior displacement of the maxilla, which contributed to the improvement in the patient's profile.

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.

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.

Twin Block appliance with acrylic capping does not have a significant inhibitory effect on lower incisor proclination

OBJECTIVE

To investigate the effect of acrylic capping, treatment duration, overjet, and lower incisor inclination on the posttreatment tooth position in patients treated with 2 Twin Block (TB) appliance versions.

MATERIALS AND METHODS

Cephalograms of 56 patients with Class II malocclusion (21 boys, 35 girls; mean age before treatment [T1] = 12.5 years; standard deviation, 0.7) treated with a TB appliance with either acrylic capping or ball-ended clasps on lower incisors were retrospectively collected and traced. Lower incisor inclination (L1-GoGn, L1-GoMe, L1-MP) was measured at T1 and after TB appliance removal (T2). Regression analysis was performed to evaluate the effect on the lower incisor inclination of appliance type, overjet, lower incisor inclination at T1, and treatment duration after adjusting for baseline measurements.

RESULTS

Appliance design was not a significant predictor for either incisor inclination measurement (P< .05). Pretreatment lower incisor inclination was the only factor significantly associated with final tooth inclination (L1-GoGn: β = 0.57, 95% confidence interval [CI] = 0.30, 0.84, P < .001; L1-GoMe: β = 0.56, 95% CI = 0.28, 0.84, P < .001; L1-MP: β = 0.46, 95% CI = 0.17, 0.75, P = .003). There was weak evidence that treatment duration excluding L1-MP (95% CI = -1.85, -0.02; P = .045) and overjet might be associated with inclination of lower incisors at T2.

CONCLUSIONS

TB appliance design with acrylic capping on lower incisors appears not to significantly control incisor proclination. Pretreatment lower incisor inclination may be significantly associated with tooth inclination after active TB treatment and should be considered in treatment planning.

Comparison of surgical and non-surgical orthodontic treatment approaches on occlusal and cephalometric outcomes in patients with Class II Division I malocclusions

BACKGROUND

This study aimed to examine end-of-treatment outcomes of severe Class II Division I malocclusion patients treated with surgical or non-surgical approaches. This study tests the hypotheses that occlusal outcomes (ABO-OGS) and cephalometric outcomes differ between these groups.

METHODS

A total of 60 patients were included: 20 of which underwent surgical correction and 40 of which did not. Cast grading of initial and final study models was performed and information was gathered from pre- to post-treatment cephalometric radiographs. The end-of-treatment ABO-OGS and cephalometric outcomes were compared to Mann-Whitney U tests and multivariable linear regression models.

RESULTS

Following adjustment for multiple confounders (age, gender, complexity of case, and skeletal patterns), the final deband score (ABO-OGS) was similar for both groups (23.8 for surgical group versus 22.5 for non-surgical group). Those treated surgically had a significantly larger reduction in ANB angle, 3.4° reduction versus 1.5° reduction in the non-surgical group (p = 0.002). The surgical group also showed increased maxillary incisor proclination (p = 0.001) compared to the non-surgical group. This might be attributed to retroclination of maxillary incisors during treatment selection in the non-surgical group-namely, extraction of premolars to mask the discrepancy.

CONCLUSIONS

Those treated surgically had a significantly larger reduction in ANB angle and increased maxillary incisor proclination compared to those treated non-surgically with no significant changes in occlusal outcomes.

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.

Changes in apical base sagittal relationship in Class II malocclusion treatment with and without premolar extractions: A systematic review and meta-analysis

OBJECTIVE

To evaluate the changes in apical base sagittal relationship in Class II treatment with and without premolar extractions.

MATERIALS AND METHODS

Controlled studies evaluating ANB angle changes after Class II Division 1 malocclusion treatment with or without premolar extractions were considered. Electronic databases (PubMed, Embase, Web of Science, Scopus, The Cochrane Library, Lilacs, and Google Scholar) without limitations regarding publication year or language were searched. Risk of bias was assessed with Risk Of Bias in Non-randomized Studies-of Interventions tool of the Cochrane Collaboration. Mean difference (MD) and 95% confidence interval (CI) were calculated from the random-effects meta-analysis. Subgroup and sensitivity analyses were also performed.

RESULTS

Twenty-five studies satisfied the inclusion criteria and were included in the qualitative synthesis. Eleven nonextraction and only one extraction Class II treatment studies presented untreated Class II control group. Therefore, meta-analysis was performed only for the nonextraction protocol. In treated Class II nonextraction patients, the average of the various effects was a reduction in the ANB angle of 1.56° (95% CI: 1.03, 2.09, P < .001) compared with untreated Class II subjects. Class II malocclusions treated with two maxillary-premolar extractions and four-premolar extractions produced estimated mean reductions in ANB of -1.88° and -2.55°, respectively. However, there is a lack of low-risk-of-bias studies.

CONCLUSIONS

According to the existing low quality evidence, the apical base sagittal relationship in nonextraction, two-maxillary and four-premolar extractions Class II treatments decreases -1.56°, 1.88° and 2.55°, respectively. Further studies are necessary to obtain more robust information.

Effect of Treatment with Twin-Block Appliances on Body Posture in Class II Malocclusion Subjects: A Prospective Clinical Study

Background

There is strong evidence that malocclusion and body posture are interdependent. The relationship between improvement of nasopharyngeal airway, correction of malocclusion by orthodontic treatment or orthognathic surgery, and changes in body posture were evaluated in several studies. The purpose of the present study was to analyze the effect of the orthodontic treatment with Twin-block appliance on body posture.

Material/Methods

The study group consisted of 23 children (mean age 12.45 (1.06) years). They were orthopedically (back shape analysis) and orthodontically (cephalometric radiograph analysis) examined before the treatment with Twin-block appliance and 10–14 months after the beginning of treatment.

Results

Treatment with Twin-block appliance caused mandibular protrusion as SNB increased by 0.91°, distance Ar-B increased by 4.9 mm, ANB decreased by 0.15°; and increase of face height. Oropharynx airway increased by 1.54 mm and deep pharynx airway by 1.08 mm. The decrease in kyphotic, lordotic, craniocervical angles, upper thoracic, pelvic, and trunk inclinations was found to be statistically significant. When comparing orthopedic measurements between study and control groups, no differences were detected. The control group also showed reduction of all measured angles. Although the decrease of kyphotic angle, upper thoracic inclination, trunk inclination, and craniocervical angle were more pronounced in the study group, the differences were not significant.

Conclusions

Based on these results, the body posture changes during treatment with Twin-block appliance were an expression of the physiological growth, not a response to improvement in occlusion.

Treatment with Twin-block appliance followed by fixed appliance therapy in a growing Class II patient

A girl, aged 11 years 4 months, with a skeletal Class II pattern and a severe overjet (10 mm) was treated with a Twin-block appliance. After 9 months of appliance therapy, the skeletal Class II was overcorrected. After 26 months of retention, when the occlusion was stable and the growth rate was diminishing, fixed orthodontic appliances using temporary skeletal anchorage devices were initiated. The total active treatment time with fixed orthodontic appliances was 30 months. Posttreatment records after 18 months demonstrated excellent stability: a functional occlusion and a pleasing facial balance. Cone-beam computed tomography was used to visualize temporomandibular joint adaptations after the functional and fixed orthodontic therapies.

Early prevention and intervention of Class II division 1 in growing patients

Early screening and diagnosis help in preventing and intercepting the severity of the malocclusion which helps in addressing the esthetic and functional concerns. Growth modulation such as mandibular advancement has been an effective procedure in orthodontics. Mandibular growth advancer (MGA) and PowerScope are gaining popularity recently as these are effective in achieving the mandibular advancement and ease of fabrication, placement, and wear. MGA was fabricated by making the upper and lower splints separately and are placed in the oral cavity by joining the two splints in the new construction bite using cold cure, MGA when worn during growth phase helps in condylar remodeling in the temporomandibular joint thus helps in advancement of the mandible. The proclination of the upper anteriors in Class II division 1 can be moved lingually by activating the labial bow in the splint. Dr. Andy Hayes worked in conjunction with American orthodontics developed PowerScope. PowerScope delivers Class II correction with a combination of patient comfort and ease of use that was unmatched among other appliances. This ready to use chairside solution required no laboratory setup, making for a much quicker, and easier installation process and appointment. PowerScopes high quality, fixed one-piece design requires no patient compliance. These superior qualities of PowerScope help in correction of Class II skeletal growing patient in conjunction with fixed orthodontic therapy. MGA and PowerScope were chosen as a functional appliance for this study, which shows decreased ANB angle and effective mandible length was increased.

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.