Evaluation of Mini Plates Anchorage in Conjunction With Forsus Fatigue Resistant Device for Correction of Skeletal Class II Malocclusion in Growing Subjects: A Randomized Controlled Trial

1. Background:

Class II malocclusions are characterized by an incorrect relationship between the maxillary and mandibular arches due to skeletal or dental problems or a combination of both. The prevalence of this malocclusion was recently found to be 20.6% in the Egyptian population in the age between 11 and 14 years with mandibular retrusion as its most common characteristic. It was also mentioned that other populations showed the predominance of the mandibular retrusion (80%) as opposed to only 20% expressing excessive maxillary development.

Class II profiles attractiveness was previously investigated in the literature. It was found that patients, their peers, orthodontists and oral surgeons, rated subjects with Class I profiles as more attractive than others with Class II profiles. It was also reported that the profile of normal adolescent patients were more favorably perceived by laypersons than untreated Class II division 1 malocclusion subjects.

In growing patients having Class II mandibular retrusion, functional orthopedic appliances are commonly used for mandibular advancement based on the concept of growth modification. However, two main problems appeared to compromise the desired treatment outcomes of these appliances; the need for patient cooperation and the lack of the possibility of combining their use with fixed appliance therapy in order to shorten treatment duration.

Many systematic reviews and meta-analyses were recently performed in the literature answering the question of whether removable functional appliances (RFAs) produced skeletal effects for correction the skeletal discrepancy through inducing actual increase in mandibular dimensions. Most recently two systematic reviews concluded that the skeletal effects of RFAs were minimal and could be considered of negligible clinical importance. They mentioned that treatment of Class II malocclusion with RFAs was associated with a minimal stimulation of mandibular growth, a minimal restriction of maxillary growth and more significant dento-alveolar and soft tissue changes.