Correction of Angle Class II division 1 malocclusion with a mandibular protraction appliances and multiloop edgewise archwire technique

Abstract

A Brazilian girl aged 14 years and 9 months presented with a chief complaint of protrusive teeth. She had a convex facial profile, extreme overjet, deep bite, lack of passive lip seal, acute nasolabial angle, and retrognathic mandible. Intraorally, she showed maxillary diastemas, slight mandibular incisor crowding, a small maxillary arch, 13-mm overjet, and 4-mm overbite. After the diagnosis of severe Angle Class II division 1 malocclusion, a mandibular protraction appliance was placed to correct the Class II relationships and multiloop edgewise archwires were used for finishing. Follow-up examinations revealed an improved facial profile, normal overjet and overbite, and good intercuspation. The patient was satisfied with her occlusion, smile, and facial appearance. The excellent results suggest that orthodontic camouflage by using a mandibular protraction appliance in combination with the multiloop edgewise archwire technique is an effective option for correcting Class II malocclusions in patients who refuse orthognathic surgery.

Optimization of Class II Malocclusion Treatments Using the Forsus™ Fatigue Resistance Device and Its Post-Treatment Effect in Adult Patients: A Case Report

“…Regarding the results presented at the end of treatment, the cephalometric analysis (Table 2) [18] show that there were dentoalveolar changes consistent with the ones already known in the literature, i.e., buccal inclination and intrusion of lower incisors [5,6,[8][9][10][11][13][14][15]17,28,35,36,37], lingual inclination and extrusion of upper incisors [2,5,6,8,[9][10][11]14,15,17,28,36,37], distalization and slight intrusion of upper molars [3,6,8,[9][10][11]13,15,36]. Lower molars were mesialized [3,6,[8][9][10][11]13,14,17], however, unlike some studies [3,…”

“…Other treatment options were considered unfavorable due to the presented clinical condition and the patient's main complaint and treatment choice. The first alternative, which was conducting an orthodontic-surgical treatment [20,28], was not accepted by the patient, furthermore, it was an extremely invasive treatment to the intra and extra-oral characteristics presented at the clinical examination and diagnosis. The second alternative, which considered extractions of upper first premolars [39,40], was also seen unfavorable due to an skeletal, not just dental, error and, also, because the patient presented a well-positioned jaw, harmonic nasolabial angle and prominent soft tissue.…”

“…The decision to treat this case using the Forsus hybrid functional appliance was taken due to the patient's main complaint, the characteristics of the malocclusion and, mainly, the facial features that have shown facial asymmetry within the normal standards, i.e., convex profile, but with passive lip seal, harmonic nasolabial angle and horizontal growth pattern [1,2,[4][5][6]8,9,12,25,28,30,33,34,35]. Other treatment options were considered unfavorable due to the presented clinical condition and the patient's main complaint and treatment choice.…”

“…The Forsus hybrid functional appliance is not as stiff as the orthopedic devices such as the Herbst [10,22,26], the APM [27,28] and the Mara [29,30], furthermore, it is not as fragile as the "Jasper Jumper" [10,11,31]. It is a comfortable device [7], as it does not completely limit the mandible movement and, in the current version, it shows a very low breakage rate [10,14,[32][33][34].…”

“…The mechanism of the dentoalveolar action of such devices over the upper anterior [2,[5][6][7][8][9][10][11]14,15,17,28,36,37] and posterior teeth [3,6,[8][9][10][11]13,35,36] and over the lower anterior [5,6,8,[9][10][11][13][14][15]17,28,[35][36][37] and posterior teeth [3,8,[9][10][11]14,17] are often responsible for the clockwise shift of the occlusal [5,9,10,16,17,35] and palatal [2] planes, generating a clockwise resultant on the mandibular plane …”