Dentoskeletal changes induced by the Jasper jumper and the activator-headgear combination appliances followed by fixed orthodontic treatment

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

“…Vertical changes have not been observed, although, the rotation of the occlusal and palatal planes, in addition to the dentoalveolar changes, have contributed to a slight clockwise rotation of the mandibular plane [9][10][11][12]15], showing a small increase of the anterior facial height [2,3,8,9,11,12,14,21]. Unlike Ruf et al [21], who have also reported increase in the posterior height of the face when using the Herbst appliance, this measurement remained stable in our patient, showing that there was no significant vertical skeletal changes at the end of treatment.…”

“…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 treatment option was, then, the use of the Forsus fixed functional appliance because it is easy to instalatt [10,11,13] and, mainly, because it provides comfort to patient, allowing greater freedom to the eccentric and centric mandible movements [7,[11][12][13][14][15][16][17]33,34], and, also, better resistance [10,13] and performance with light forces (average of 220 to 250g) [15,35]. Other functional appliances, such as the Herbst and the Jasper-jumper, provide, in a long-term run, the same dentoskeletal results as the hybrid appliances [8,11,12,18,19,[21][22][23]25]. However, the Herbst appliance, because it is stiff and restricts mandibular move, it is considered extremely uncomfortable to adult patients, in addition to presenting high breakage levels and complex installation [10,22,26].…”

“…Based on this and supported by the literature, it was possible to consider and suggest some treatment options to the patient, such as a surgical-orthodontic treatment [20,38]; upper first molar extractions [39,40], the use of intermaxillary Class II elastics [24,41], which would need patient cooperation; and the use of fixed functional appliances-rigid [18,19,[21][22][23]25], semi-rigid [8,11,12,37], but, mainly, hybrid appliances as the Forsus™ Fatigue Resistant Device [3,7,11,[13][14][15]17,[32][33][34]35]. The chosen protocol was to use the Forsus™ Fatigue Resistant Device that has shown to be an effective device, providing greater comfort to patients [7,11,[14][15][16][17]33,34] and good resistance [10,13,15,35] when treating Class II malocclusions.…”

“…Such considerations occurred due to the lack of studies comparing the control group, presenting the same malocclusion, to the treated group [5,6], the lack of patient's cooperation [7][8][9], the use of removable orthopedic devices in growing patients [8], the high breakage rate of fixed orthopedic appliances [10][11][12][13], and, discomfort caused to patients by the use of removable and fixed orthopedic devices [10,11,13]. In the twenty-first century, the launch of the Forsus™ Fatigue Resistant Device brought a new proposal to treatments, considering patient comfort in the set-up day and along the treatment, due to the lack of mandibular postural change and easiness of performing the functional mandibular movements [7,11,[14][15][16][17].…”