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.

Time of maxillary molar distalization with non-compliance intraoral distalizing appliances: a meta-analysis.

BACKGROUND/OBJECTIVE: To assess the mean maxillary molar distalization time with non-compliance intraoral distalizing appliances. SEARCH METHODS AND SELECTION CRITERIA: Database search included PubMed, Web of Science, Scopus, The Cochrane Library, Lilacs, and a partial grey literature through Google Scholar and OpenGrey. The search was performed until May 2017 and updated on February 2019, without limitations regarding publication year or language. Controlled clinical trials (randomized and non-randomized prospective studies) reporting duration of maxillary molar distalization of Class II patients treated with intraoral distalizers were included. DATA COLLECTION AND ANALYSIS: For the trials' quality assessment, the Cochrane Risk of Bias tool and the Cochrane Collaboration's ROBINS-I tool were used for the randomized controlled trials and non-randomized prospective studies, respectively. Database research, risk of bias (RoB) assessment, and extraction of data were performed by two independent investigators, with inclusion of a third reviewer, if disagreements emerged. Data was combined through a random-effects meta-analysis. Subgroup analyses regarding side of force application, type of anchorage, amount of molar distalization, and sensitivity analysis comparing study designs were also performed. Quality of evidence was assessed using the GRADE and SORT approaches. RESULTS: Nine studies were included in the qualitative analysis; however, a meta-analysis was performed with only four studies, due to the presence of high RoB in the other studies. The random-effects meta-analysis assumes that the mean distalization time with distalizers is 8.34 months (95% confidence interval: 6.10, 10.58). Another meta-analysis was performed to evaluate the relationship between distalization time and the type of anchorage (conventional or skeletal), resulting in no significant difference. Both meta-analyses presented low-quality evidence. LIMITATIONS: The major limitation of this meta-analysis is the fact that distalization time can be affected by a great range of factors. CONCLUSIONS AND IMPLICATIONS: Correction of a half-to-full cusp Class II molar relationship with intraoral distalizers can be achieved in 8.34 months, and this distalization time may not be affected by the kind of anchorage used. REGISTRATION: The protocol for this systematic review was based on the Cochrane Handbook for Systematic Reviews of Interventions 5.1.0 and was registered at PROSPERO database (http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42017068737). This systematic review is reported according to the PRISMA statement.

Comparison of dentoskeletal and soft tissue effects of Class II malocclusion treatment with Jones Jig appliance and with maxillary first premolar extractions.

OBJECTIVE: The aim of this study was to compare the cephalometric changes in Class II division 1 malocclusion patients treated with Jones Jig appliance or with maxillary first premolar extractions. METHODS: The sample consisted of 88 lateral cephalograms of 44 patients, divided into two groups. Group 1 consisted of 21 patients treated with Jones Jig appliance, with a mean initial age of 12.88 ± 1.23 years and final mean age of 17.18 ± 1.37 years, and a mean treatment time of 4.29 years. Group 2 comprised 23 patients treated with maxillary first premolar extractions, with a mean initial age of 13.59 ± 1.91 years and mean final age of 16.39 ± 1.97 years, and a mean treatment time of 2.8 years. Intergroup treatment changes were compared with t and Mann-Whitney tests. RESULTS: Class II correction in G2 (maxillary first premolar extractions) presented significantly greater maxillary retrusion, reduction of anteroposterior apical base discrepancy, smaller increase in the lower anterior face height and significantly greater overjet reduction than G1 (Jones Jig). CONCLUSIONS: Treatment with maxillary first premolar extractions produced greater overjet reduction, but the two treatment protocols produced similar changes in the soft tissue profile.

Estudo comparativo das alterações cefalométricas do tratamento da má oclusão de Classe II com os aparelhos propulsores jasper jumper e forsus fatigue resistant device, associados ao aparelho fixo / Treatment effects produced by the jasper jumper vs the forsus fatigue resistant device, associated with fixed orthodontic appliances, in growing Class II patients

Objetivo: O objetivo deste estudo foi comparar as alterações cefalométricas depacientes com má oclusão de Classe II divisão 1 tratados com os aparelhos JasperJumper e Forsus Fatigue Resistant Device, associados ao aparelho ortodôntico fixo.Material e métodos: A amostra foi constituída por 124 telerradiografias em normalateral de 62 indivíduos, os quais foram divididos em 3 grupos: Grupo Experimental 1(n=22, idade inicial=12,39 anos), tratados por meio do aparelho Jasper Jumperassociado ao aparelho fixo, por um período médio de 2,43 anos; Grupo Experimental2 (n=19, idade inicial=12,43 anos), tratados com o aparelho Forsus associado aoaparelho fixo, com tempo médio de tratamento de 3,54 anos; Grupo Controle (n=22,idade inicial 12,14 anos), observados por um período médio de 1,78 anos. Asalterações de todas as variáveis cefalométricas dos grupos experimentais foramanualizadas e, posteriormente, comparadas às alterações das variáveis do grupoControle, por meio da Análise de Variância e do teste de Tukey. Resultados:Observou-se que ambos os tratamentos apresentaram um efeito restritivo na maxila;não alteraram o desenvolvimento mandibular; melhoraram a relaçãomaxilomandibular; promoveram rotação horária do plano oclusal e um suaveaumento da altura facial anteroinferior. Os grupos experimentais apresentaramlimitação do desenvolvimento vertical dos molares superiores; inclinação paravestibular e limitação do desenvolvimento vertical dos incisivos inferiores; e extrusãodos molares inferiores. Os incisivos inferiores exibiram maior protrusão no grupo 1em relação aos demais grupos. Ambos os aparelhos melhoraram significantementea relação maxilomandibular, os trespasses horizontal, vertical e a relação molar. Osprotocolos de tratamento promoveram retrusão dos lábios superiores. O grupo 2apresentou suave protrusão dos lábios inferiores e os grupos 1 e 3 apresentarampequena retrusão...

Objective: The aim of this study was to compare the cephalometric changes of ClassII division 1 malocclusion patients treated with Jasper Jumper and Forsus FatigueResistant Device, associated with fixed appliances. Methods: The sample consistedof 124 lateral cephalograms of 62 individuals, divided into 3 groups: Group 1 (n=22,mean age=12.39 years), treated with the Jasper Jumper appliance associated withfixed appliances for a mean period of 2.43 years; Group 2 (n=19, mean age=12.43years), treated with the Forsus appliance associated with fixed appliances, with amean treatment time of 3.54 years; and the Control group (n=22, mean age=12.14years), followed for a mean period of 1.78 years. The changes of all cephalometricvariables in the study groups were annualized and then compared to the changesobserved for the Control group, by analysis of variance and Tukey test. Results: Itwas observed that both treatments presented a restrictive effect on the maxila; didnot change the mandibular development; improved maxillomandibular relationship;produced clockwise rotation of the occlusal plane; and a slight increase in loweranterior facial height. Study groups showed limitation on the vertical development ofthe maxillary molars; buccal tipping and limitation on the vertical development of themandibular incisors; and extrusion of mandibular molars. The mandibular incisorsexhibited greater protrusion in the group 1 compared to other groups. Bothappliances provided significant improvement of maxillomandibular relationship,overjet, overbite and molar relationship. Treatment protocols promoted retrusion ofthe upper lip. Group 2 presented mild protrusion of the lower lip and groups 1 and 3showed mild retrusion. Conclusion: Both the appliances were effective in thetreatment of Class II malocclusion.

Estudo comparativo das alterações cefalométricas do tratamento da má oclusão de Classe II com os aparelhos propulsores jasper jumper e forsus fatigue resistant device, associados ao aparelho fixo / Treatment effects produced by the jasper jumper vs the forsus fatigue resistant device, associated with fixed orthodontic appliances, in growing Class II patients

Objetivo: O objetivo deste estudo foi comparar as alterações cefalométricas depacientes com má oclusão de Classe II divisão 1 tratados com os aparelhos JasperJumper e Forsus Fatigue Resistant Device, associados ao aparelho ortodôntico fixo.Material e métodos: A amostra foi constituída por 124 telerradiografias em normalateral de 62 indivíduos, os quais foram divididos em 3 grupos: Grupo Experimental 1(n=22, idade inicial=12,39 anos), tratados por meio do aparelho Jasper Jumperassociado ao aparelho fixo, por um período médio de 2,43 anos; Grupo Experimental2 (n=19, idade inicial=12,43 anos), tratados com o aparelho Forsus associado aoaparelho fixo, com tempo médio de tratamento de 3,54 anos; Grupo Controle (n=22,idade inicial 12,14 anos), observados por um período médio de 1,78 anos. Asalterações de todas as variáveis cefalométricas dos grupos experimentais foramanualizadas e, posteriormente, comparadas às alterações das variáveis do grupoControle, por meio da Análise de Variância e do teste de Tukey. Resultados:Observou-se que ambos os tratamentos apresentaram um efeito restritivo na maxila;não alteraram o desenvolvimento mandibular; melhoraram a relaçãomaxilomandibular; promoveram rotação horária do plano oclusal e um suaveaumento da altura facial anteroinferior. Os grupos experimentais apresentaramlimitação do desenvolvimento vertical dos molares superiores; inclinação paravestibular e limitação do desenvolvimento vertical dos incisivos inferiores; e extrusãodos molares inferiores. Os incisivos inferiores exibiram maior protrusão no grupo 1em relação aos demais grupos. Ambos os aparelhos melhoraram significantementea relação maxilomandibular, os trespasses horizontal, vertical e a relação molar. Osprotocolos de tratamento promoveram retrusão dos lábios superiores. O grupo 2apresentou suave protrusão dos lábios inferiores e os grupos 1 e 3 apresentarampequena retrusão...

Objective: The aim of this study was to compare the cephalometric changes of ClassII division 1 malocclusion patients treated with Jasper Jumper and Forsus FatigueResistant Device, associated with fixed appliances. Methods: The sample consistedof 124 lateral cephalograms of 62 individuals, divided into 3 groups: Group 1 (n=22,mean age=12.39 years), treated with the Jasper Jumper appliance associated withfixed appliances for a mean period of 2.43 years; Group 2 (n=19, mean age=12.43years), treated with the Forsus appliance associated with fixed appliances, with amean treatment time of 3.54 years; and the Control group (n=22, mean age=12.14years), followed for a mean period of 1.78 years. The changes of all cephalometricvariables in the study groups were annualized and then compared to the changesobserved for the Control group, by analysis of variance and Tukey test. Results: Itwas observed that both treatments presented a restrictive effect on the maxila; didnot change the mandibular development; improved maxillomandibular relationship;produced clockwise rotation of the occlusal plane; and a slight increase in loweranterior facial height. Study groups showed limitation on the vertical development ofthe maxillary molars; buccal tipping and limitation on the vertical development of themandibular incisors; and extrusion of mandibular molars. The mandibular incisorsexhibited greater protrusion in the group 1 compared to other groups. Bothappliances provided significant improvement of maxillomandibular relationship,overjet, overbite and molar relationship. Treatment protocols promoted retrusion ofthe upper lip. Group 2 presented mild protrusion of the lower lip and groups 1 and 3showed mild retrusion. Conclusion: Both the appliances were effective in thetreatment of Class II malocclusion.

Effects of cervical headgear appliance: a systematic review.

OBJECTIVE: Although much has been investigated about the effects of cervical headgear, there remains some controversy. Therefore, the objective of this systematic review is to disclose the actual effects of the cervical headgear appliance, based on articles of relevant quality. METHODS: A literature review was conducted using PubMed, Web of Science, Embase, Scopus and Cochrane databases. Inclusion criteria consisted of human studies written in English; published between 1970 and 2014; in which only the cervical headgear was used to correct Class II malocclusion; prospective or retrospective; with a clear description of cervical headgear effects; with a sample size of at least 15 individuals. No comparative studies, clinical cases or cases with dental extractions were included and the sample should be homogeneous. RESULTS: Initially, 267 articles were found. A total of 42 articles were selected by title and had their abstracts read. Finally, 12 articles were classified as with high quality and were used in this systematic review. CONCLUSIONS: The cervical headgear appliance proved efficient to correct Class II, Division 1 malocclusion. Its effects consisted in correction of the maxillomandibular relationship by restriction of maxillary anterior displacement; distalization and extrusion of maxillary molars; and slight maxillary expansion.

Effects of cervical headgear appliance: a systematic review

OBJECTIVE: Although much has been investigated about the effects of cervical headgear, there remains some controversy. Therefore, the objective of this systematic review is to disclose the actual effects of the cervical headgear appliance, based on articles of relevant quality.METHODS: A literature review was conducted using PubMed, Web of Science, Embase, Scopus and Cochrane databases. Inclusion criteria consisted of human studies written in English; published between 1970 and 2014; in which only the cervical headgear was used to correct Class II malocclusion; prospective or retrospective; with a clear description of cervical headgear effects; with a sample size of at least 15 individuals. No comparative studies, clinical cases or cases with dental extractions were included and the sample should be homogeneous.RESULTS: Initially, 267 articles were found. A total of 42 articles were selected by title and had their abstracts read. Finally, 12 articles were classified as with high quality and were used in this systematic review.CONCLUSIONS: The cervical headgear appliance proved efficient to correct Class II, Division 1 malocclusion. Its effects consisted in correction of the maxillomandibular relationship by restriction of maxillary anterior displacement; distalization and extrusion of maxillary molars; and slight maxillary expansion.

OBJETIVO: embora muitos estudos investiguem os efeitos do AEB cervical, ainda há algumas controvérsias sobre os seus efeitos. Portanto, o objetivo desta revisão sistemática é divulgar os efeitos reais do aparelho extrabucal cervical, com base em artigos com qualidade.MÉTODOS: os artigos foram pesquisados por meio das bases de dados PubMed, Web of Science, Embase, Scopus e Cochrane. Os critérios de inclusão consistiram em: estudos em humanos escritos em inglês; publicados entre 1970 e 2014; apenas o AEB cervical foi utilizado para corrigir má oclusão de Classe II; prospectivos ou retrospectivos; com uma descrição clara dos efeitos do aparelho; com um tamanho de amostra de pelo menos 15 indivíduos. Estudos comparativos, relatos de caso ou casos com extrações não foram incluídos e a amostra deveria ser homogênea.RESULTADOS: inicialmente, 267 artigos foram encontrados; e 42 artigos desses foram selecionados pelo título, tendo seus resumos lidos. Por fim, 12 artigos foram classificados como de alta qualidade e foram utilizados na presente revisão sistemática.CONCLUSÕES: o aparelho extrabucal cervical foi eficiente para corrigir a má oclusão de Classe II divisão 1. Seus efeitos são correção da relação maxilomandibular, com restrição do deslocamento anterior da maxila; distalização e extrusão dos molares superiores e ligeira expansão maxilar.

Correção da má-oclusão de classe II com o aparelho Forsus / Class II malocclusion correction with the Forsus device

Atualmente, há uma grande variedade de terapêuticas disponíveis para a correção da má-oclusão de classe II. Os protocolos mais eficientes são aqueles que não dependem da colaboração do paciente. Nos últimos anos, diversos aparelhos funcionais fixos foram idealizados e utilizados para o tratamento da má-oclusão de classe II na dentadura permanente. Os aparelhos funcionais fixos são vantajosos, pois eles são efetivos 24 horas por dia, não necessitam da colaboração dos pacientes em utilizá-los, podem ser associados ao aparelho fixo e o tratamento ativo é mais curto. Dentre estes aparelhos, destaca-se o Forsus, que foi desenvolvido em 1999 por William Vogt. O Forsus Fatigue Resistant Device é um aparelho de propulsão híbrido intrabucal de ancoragem intermaxilar recíproca, que utiliza uma combinação de um sistema de força flexível e rígido para corrigir a má-oclusão de classe II por meio da protrusão mandibular. O aparelho Forsus diferencia-se dos demais aparelhos funcionais fixos, pois apresenta fácil instalação e permite maior liberdade de movimentação da mandíbula. Dessa forma, o objetivo deste trabalho foi apresentar, por meio de um caso clínico, os efeitos do aparelho Forsus no tratamento da má-oclusão de classe II...

Currently, there is a variety of therapies available for the correction of class II malocclusion. The most efficient protocols are those that do not depend on patient compliance. In recent years, several fixed functional appliances were designed and used for the treatment of class II malocclusion in the permanent dentition. Fixed functional appliances are advantageous because they are effective 24 hours a day, do not require the cooperation of patients to use them, can be associated with fixed appliances and the active treatment is shorter. Among these devices, highlight the Forsus, which was developed in 1999 by William Vogt. The Forsus Fatigue Resistant Device is an intraoral hybrid propulsion device with reciprocal intermaxillary anchorage, which uses a combination of a system of flexible and rigid strength to correct class II malocclusions by mandibular protrusion. The Forsus device differs from other fixed functional appliances due to its features of easy installation and allows greater freedom of movement of the mandible. Thus, the aim of this paper is to show through a case report the effects of the Forsus device in the treatment of class II malocclusion...

Correção da má oclusão de Classe II com o aparelho Jasper Jumper - relato de caso / Correction of Class II malocclusion with Jasper Jumper appliance - case report

A má oclusão de Classe II caracteriza-se por fatores esqueléticos e dentários, nas quais as alterações observadas no sentido anteroposterior se concentram em estruturas esqueléticas e/ou dentoalveolar da maxila e mandíbula. A correção da Classe II pode ser alcançada por meio de diversas mecânicas ortodônticas, cabendo ao ortodontista determinar o melhor método para cada paciente. O Jasper Jumper é um aparelho fixo e flexível indicado para correção da Classe II, especialmente quando se diagnostica retrognatismo mandibular. Este aparelho é utilizado conjuntamente com a aparelhagem fixa, reduzindo o tempo total de tratamento. Além disso, o Jasper Jumper promove uma força contínua, sem a necessidade da colaboração do paciente em utilizá-lo. Este trabalho apresenta uma bordagem simples e eficaz do tratamento ortodôntico da má oclusão Classe II utilizando o aparelho Jasper Jumper que possibilitou, além da correção da má oclusão, a melhora no perfil da paciente.

The Class II malocclusion is characterized by skeletal and dental factors, in which the observed changes in the anteroposterior direction focus on skeletal and/or dentoalveolar structures of the maxilla and mandible. The Class II malocclusion correction can be achieved by means of several orthodontic mechanics being the orthodontist who determines the best method for each patient. The Jasper Jumper is a fixed and flexible appliance indicated for Class II malocclusion correction mainly when mandibular retrognathism is diagnosed. This appliance is worn in association with fixed appliances reducing in this way the total treatment time. Moreover, the Jasper Jumper promotes a continuous force without the patient’s compliance in wearing it. Therefore, this article presents a simple and effective approach to orthodontic treatment of Class II malocclusion with the Jasper Jumper appliance, which enabled not only the Class II malocclusion correction but also the improvement in the patient’s profile.

Diferentes sistemas de distalização de molares utilizando ancoragem esquelética indireta - relato de casos / Different systems of molar distalization using indirect skeletal anchorage - case reports

Uma opção de tratamento da má oclusão de Classe II dentária é a utilização de distalizadores intrabucais que costumam apresentar efeitos de perda de ancoragem nos dentes anteriores quando utilizado uma ancoragem convencional. Para minimizar esses efeitos a distalização pode ser realizada com apoio em mini-implantes que devido à sua versatilidade podem ser instalados em diferentes locais na cavidade bucal, proporcionando diferentes maneiras de se realizar essa mecânica. O objetivo deste artigo é apresentar dois casos clínicos da correção da má oclusão de Classe II com o uso de diferentes sistemas de distalização de molares associados à ancoragem esquelética indireta. No primeiro caso foi utilizado ancoragem esquelética por meio de mini-implantes instalados entre os pré-molares e molares superiores por vestibular e a distalização realizada com molas de NiTi. No segundo caso foi utilizado o aparelho distalizador First Class ancorado em mini-implantes no palato. Ambos mecanismos apresentaram distalização eficiente. O sistema com ancoragem no palato possui a vantagem de realizar apenas uma etapa cirúrgica de inserção dos mini-implantes, enquanto que na ancoragem por vestibular deve ser realizada outra cirurgia para reposicioná-los e permitir a retração anterior. A utilização desses sistemas minimizou os efeitos colaterais mostrando que mecânicas de distalização podem ser melhor controladas quando se utiliza ancoragem esquelética.

An option for treatment of Class II malocclusion is the use of intraoral distalizers, which often show effects of anchorage loss in anterior teeth when a conventional anchorage is used. To minimize these effects, mini-implant supported distalization can be performed. Due to their versatility, mini-implants can be placed in different locations in the oral cavity, enabling different ways of performing orthodontic mechanics. The objective of this paper was to present two cases of correction of Class II malocclusion with the use of different molar distalization systems associated with indirect skeletal anchorage. In the first case, skeletal anchorage was obtained by mini-implants inserted between maxillary premolars and molars buccally, and distalization performed with NiTi springs. In the second case, the First Class appliance was used, anchored to mini-implants in the palate. Both mechanisms presented efficient distalization. The system with anchorage in the palate has the advantage of requiring only one surgical step for mini-implant insertion, while for anchorage in the buccal region, another surgery is required to reposition them and allow anterior retraction. The use of these systems has minimized side effects of distalization, showing that mechanics can be better controlled when using skeletal anchorage.

Aplicação dos distalizadores de molares superiores no tratamento da má oclusão de Classe II predominantemente dentária / Application of intraoral distalizing appliances in the treatment of dental Class II malocclusion

O tratamento da má oclusão de Classe II dentária pode ser realizado por meio da distalização dos molares superiores. Atualmente, os aparelhos distalizadores intrabucais vêm se destacando com sucesso, dentre os quais, pode-se citar o Jones Jig. O aparelho Jones Jig é eficiente na distalização dos molares superiores pela liberação de força constante de 75 gramas quando ativado. Apesar de sua eficácia, este dispositivo promove efeitos colaterais de perda de ancoragem, protrusão dos incisivos e aumento da altura facial. Deste modo, o Jones Jig é contraindicado para pacientes dolicofaciais. O propósito deste artigo é apresentar um caso clínico de má oclusão de Classe II dentária tratado com o aparelho distalizador Jones Jig, assim como demonstrar cefalometricamente as alterações dentoesqueléticas e tegumentares que contribuíram para a correção.

Class II malocclusion can be treated by distalization of the maxillary molars. Currently intraoral distalizing appliances have stood out successfully, among which we can mention the Jones Jig appliance. The Jones Jig appliance is effective in distalization of maxillary molars by releasing constant force of 75 grams when activated. Despite its effectiveness, this appliance promotes side effects such as loss of dental anchorage, incisor protrusion and facial height increase. Thus, the Jones Jig is contraindicated in dolichofacials patients. The purpose of this article is to present a case of dental Class II malocclusion treated with Jones Jig appliance, as well as demonstrate cephalometrically dental, skeletal and soft tissue changes that contributed to the correction.