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

OBJECTIVES

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

MATERIALS AND METHODS

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

RESULTS

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

CONCLUSIONS

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

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

OBJECTIVES

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

MATERIALS AND METHODS

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

RESULTS

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

CONCLUSIONS

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

Changes in Soft Tissue Profile After Orthodontic Treatment With and Without Extraction: A Systematic Review and Meta-analysis

OBJECTIVE

The objective of this systematic review and meta-analysis was to evaluate the soft tissue changes in adult orthodontic patients who received extraction treatment in comparison to their counterparts who received nonextraction orthodontic treatment.

METHODS

Electronic databases (CENTRAL-Cochrane Register of Controlled Trials, PubMed, Embase, EBESCOhost, LILACS, and Google Scholar) were searched up to March 2015. Handsearching was performed too. The selection process included controlled trials (prospective or retrospective and randomized or nonrandomized) on adult patients receiving orthodontic extraction treatment compared within the same study to a group treated without extraction. The outcomes of interest were the changes in linear and angular cephalometric measurements specific for soft tissue profile. Studies which fulfilled the selection criteria were retrieved. They were assessed for methodological quality based on a validated checklist. Studies of moderate to high quality were included.

RESULTS

Of the nine full texts which fulfilled the selection criteria, 5 were eligible for the quantitative analysis; they scored a moderate quality. Meta-analysis showed a significant increase regarding the nasolabial angle, upper lip thickness, labrale superioris to E-Line, and labrale inferioris to E-line in the extraction group, suggesting the flattening of the profile following extraction treatment.

CONCLUSION

A significant retraction of the lips and an increase in the nasolabial angle are associated with extraction protocols, but the degree to which these changes are considered detrimental/beneficial to the profile could be affected by different factors. Since these finding are based on studies of moderate quality, future research with well-conducted methodologies are highly recommended.

Fixed functional appliances with multibracket appliances have no skeletal effect on the mandible: A systematic review and meta-analysis

INTRODUCTION

Our aim was to assess the skeletal mandibular changes (anteroposterior and vertical) in circumpubertal patients with fixed functional appliances installed on multibracket appliances compared with untreated patients.

METHODS

An open-ended electronic search of 4 databases (PubMed, Embase, Cochrane Library, and Web of Science) up to April 2014 was performed. Additional searches of relevant journals, reference lists of the retrieved articles, systematic reviews, and gray literature were performed. Specific inclusion and exclusion criteria were applied to identify relevant articles. Quality was evaluated using the Cochrane Collaboration risk of bias tool and the Newcastle-Ottawa scale for prospective controlled clinical trials. Meta-analyses were conducted with fixed and random effects models as appropriate. Statistical heterogeneity was also examined.

RESULTS

Seven articles were included in the qualitative synthesis and 5 in the meta-analysis. The included randomized controlled trials were at high risk of bias, and the methodologic quality of the prospective controlled clinical trials was high. Based on assessment of the fixed functional appliance phase in isolation, no difference in mandibular anteroposterior positional changes (SNB angle) (standard mean difference, 0.11°; 95% CI, -0.28, 0.50) was found between the treated and control groups. The vertical dimension was not influenced by the fixed functional appliance treatment.

CONCLUSIONS

There is little high-quality evidence concerning the relative influence of fixed functional appliances on skeletal and dentoalveolar changes. However, based on the limited evidence, it appears that they have little effect on the skeletal mandibular parameters.

Occlusal splint therapy and magnetic resonance imaging

AIMS

To investigate the efficacy of the anterior repositioning splint and the canine-protected splint in relieving the signs and symptoms of anterior disc displacement with reduction, and to evaluate the effects of both splints on disc position using a standardized magnetic resonance imaging measurement technique.

MATERIAL AND METHODS

A sample of 18 adult subjects was studied. The joint disorder was dually diagnosed via pretreatment clinical examination and magnetic resonance imaging. The sample was randomly divided into two groups. In the first group, each subject received an anterior repositioning splint; in the second group, each subject received a canine-protected splint. The treatment lasted 3 months. A standardized magnetic resonance imaging 10-step procedure was developed. Posttreatment clinical examinations and magnetic resonance imagings were done. Pretreatment and posttreatment records were statistically compared.

RESULTS AND CONCLUSIONS

Both types of splints were effective in eliminating pain and clicking. All magnetic resonance imaging measurements showed that the canine-protected splint was superior to the anterior repositioning splint, as it allowed the articular disc to resume its normal length and shape while moving in a posterior direction toward recapture. Disc recapture was demonstrated via magnetic resonance imaging in 25% of the subjects from the anterior repositioning splint group, in 40% of the subjects from the canine-protected splint group, and in 33.3% of the subjects from both groups. Thus, noninvasive treatment techniques (such as occlusal splint therapy) might be the treatment of choice for anterior disc displacement with reduction.