Evaluation of external apical root resorption caused by fixed functional treatment of class II malocclusion : Cast splint Herbst appliance vs. Forsus fatigue resistant device.

INTRODUCTION: The aim of this study was to evaluate and compare the effects of class II fixed functional treatment with a cast splint Herbst appliance (HA; Herbst Set I, Dentaurum, Ispringen, Germany) and Forsus fatigue resistant device (FRD; 3M Unitek Corp., Monrovia, CA, USA) on external apical root resorption (EARR) in posterior teeth. METHODS: In all, 40 patients (15 male and 25 female) with class II division 1 malocclusion were treated with two fixed functional appliances: HA (20 patients, mean age 14.60 ± 1.14 years) and FRD (20 patients, mean age 14.15 ± 1.28 years). The vestibular lengths of the first molars and premolars were measured on panoramic radiographs and converted to actual tooth length using the magnification coefficient (MC), which was calculated using dental models. Intragroup comparisons of pre- and posttreatment tooth lengths were performed with the paired t­test and Wilcoxon signed-rank test, while intergroup comparisons were performed with the Mann-Whitney U test. RESULTS: Pretreatment tooth length values decreased significantly with HA and FRD therapies for all posterior teeth. The maximum resorption was observed in the mandibular first premolar with a mean of 0.81 mm following HA and 1.55 mm following FRD treatment. While no significant difference existed between the EARR values of the HA and FRD groups for maxillary teeth, the amount of EARR of mandibular posterior teeth in the FRD group was significantly higher than in the HA group. CONCLUSIONS: In patients treated with HA or FRD, the tooth length of posterior teeth decreased to a clinically minor but statistically significant degree. The root resorption effect of FRD therapy in mandibular posterior teeth was significantly higher than that of HA therapy.

Tratamento de má oclusão de Classe II por meio de distalização sequencial posterior com alinhadores ortodônticos ClearCorrect / Treatment of Class II malocclusion through upper distalization with ClearCorrect aligners

Resumo A segunda mais prevalente má oclusão de Angle na população é a de Classe II. Dentre as abordagens de tratamento consideradas pelos profissionais, está a distalização dos dentes posteriores superiores ou exodontias. A distalização, dependendo do nível de complexidade do caso, pode ser desafiadora e necessitar de mecânicas auxiliares para realizar movimentos translacionais e não somente de inclinação coronária. A escolha da abordagem para esses tratamentos depende diretamente da colaboração do paciente, severidade da má oclusão, caracterização da Classe II, idade do paciente e habilidade técnica do profissional responsável. Com o aumento da procura por tratamentos ortodônticos mais estéticos, os alinhadores ortodônticos têm sido frequentemente uma alternativa aos pacientes. Dependendo da severidade da má oclusão, pode-se associar aos auxiliares comumente utilizados na Ortodontia convencional fixa. Portanto, o objetivo deste trabalho é apresentar a resolução de uma má oclusão de Classe II, divisão 1, com impactação do canino superior direito e desvio de linha média superior para a direita tratada com alinhadores ortodônticos ClearCorrect. (AU)

Abstract The second more prevalent Angle's malocclusion on the population is Class II. Among the continuously considered treatment approaches by clinicians, is the distalization of upper teeth or extractions. The distalizations, depending on the case's complexity, can be challenging and need auxiliary mechanics to perform translation movements and not just crown tipping. The choose of the appliance for these treatments relies directly on the option/collaboration of the patient, malocclusion severeness, patient's age, and technical ability of the main professional taking care of the case. With the crescent search for more aesthetic orthodontic treatments, the clear aligners have been frequently looked for by the patients as an alternative and, regularly related to auxiliaries commonly associated to the conventional fixed appliances. Regarding this context, the objective of this study is to present the case report of a patient with Class II, division 1, upper midline deviation to the right and unerupted upper right canine through the ClearCorrect aligners' system. (AU)

O distalizador Carriere como coadjuvante no tratamento da má oclusão de Classe II, Divisão 1 / The Carriere distalizer as an adjunct in the treatment of Class II, Division 1 malocclusion

Resumo O objetivo deste relato de caso é descrever o tratamento ortodôntico realizado em uma paciente de 15 anos, sexo feminino, com má oclusão Classe II, Divisão 1, com aparelho Carriere Motion 3D (ACM), seguido de aparelhos fixos completos. O exame intraoral mostrou uma má oclusão de Classe II, Divisão 1, com overbite de 1 mm e overjet de 3,5 mm. O arco superior com morfologia triangular e o mandibular parabólico, além da ausência da coroa clínica do primeiro molar inferior direito. O tratamento iniciou com a utilização simultânea do ACM e de uma contenção Essix para ancoragem do arco mandibular. Nesse período, elásticos de Classe II foram empregados durante 5 meses, obtendo-se a relação molar e canino de Classe I. Posteriormente, bráquetes metálicos MBT .022" foram utilizados em ambas as arcadas. Os resultados demonstraram estabilidade ao longo de um período de dois anos de acompanhamento, com satisfação da paciente (AU)

Abstract The aim of this case report is to describe the orthodontic treatment performed on a 15-year-old female patient, with Class II, Division 1 malocclusion, using the Carriere Motion 3D appliance (ACM) followed by full fixed appliances. The intraoral examination showed a Class II, Division 1 malocclusion, with 1 mm overbite and 3.5 mm overjet. The maxillary arch had a triangular morphology and the mandibular arch was parabolic, in addition to the absence of the clinical crown of the right mandibular first molar. Treatment began with the simultaneous use of ACM and an Essix retainer for anchoring the mandibular arch. During this period, Class II elastics were applied for 5 months, achieving Class I molar and canine relation. Subsequently, MBT .022" metal brackets were used on both arches. The results demonstrated stability over a two-year follow-up period, with patient satisfaction (AU)

Tratamento da má oclusão de Classe II com o propulsor mandibular PMW: acompanhamento de 4 anos / Treatment of CL II malocclusion with the PMW-type mandibular propulsion: 4-year follow-up

O presente artigo teve como objetivo descrever, por meio de um caso clínico, o manejo ortopédico com intenção corretiva de um paciente Padrão II por retrusão mandibular, má oclusão de Classe II divisão 1 e face aceitável. Relato do caso: O paciente foi submetido a um tratamento com o propulsor mandibular Westerich (PMW) associado à ortodontia fixa. Resultados: A terapia utilizada proporcionou a correção da relação sagital de Classe II, com considerável ganho estético no perfil facial em razão da suavização da ângulo mentolabial e da compensação com inclinação vestibular dos incisivos inferiores. No acompanhamento de 4 anos pôde-se observar excelente estabilidade do tratamento com manutenção dos efeitos dentoalveolares, boa qualidade da tábua óssea vestibular e da inserção gengival dos incisivos inferiores. Conclusão: o aparelho ortopédico fixo PMW é uma opção eficaz para o tratamento de paciente Padrão II por deficiência mandibular quando os objetivos, principalmente, de ordem dentoalveolares são almejados. O aparelho é de fácil instalação, confortável e depende minimamente da cooperação do paciente, além de proporcionar resultados extremamente satisfatórios com a correção das relações oclusais e estabilidade a longo prazo (AU)

Introduction: The paper describes, through a case report, an orthopedic management of a Pattern II with mandibular retrusion patient, associated with Class II division 1 malocclusion and an acceptable face. Case report: The patient underwent treatment with the Westerich fixed functional device (PMW) associated with fixed orthodontics. Results: The therapy provided correction of the Class II sagittal relationship, with considerable aesthetic improvement due to smoothing of the mentolabial angle and dental compensation by buccal inclination of the lower incisors. 4-year follow-up showed excellent stability and maintenance of dentoalveolar effects. Also, good quality of the buccal bone plate and gingival insertion of the lower incisors were observed. Conclusion: PMW is an effective option for the Pattern II patients with mandibular deficiency treatment when, mostly dentoalveolar effects, are pursued. The device has easy installation, is comfortable and depends minimally on the patient's cooperation. In addition, it provides satisfactory results with the correction of occlusal relationships and long-term stability.(AU)

[Early orthodontic/orthopedic treatment in patients with class II sagittal anomalies. A review]. / Tratamiento temprano ortodóncico/ortopédico en pacientes con anomalías sagitales de clase II. Una revision.

Introduction: Class II sagittal anomalies have a prevalence of between 18-32% of the population. To resolve this type of malocclusion, various therapies have been proposed, some of which involve functional orthodontic or orthopedic appliances. However, it is still a matter of discussion whether the treatments should be started at an early age in patients, or if there are adverse effects that could harm structures of the stomatognathic system. Objective: To analyze the results obtained from early treatment in patients with Class II sagittal malocclusion through a literature review. Materials and methods: An advanced search with terms and connectors was carried out in the Medline via Pubmed and Science Direct databases. Inclusion and exclusion criteria were applied for the definitive selection. Results: Through this search, a total of 5909 articles were collected, of which 23 were considered to meet the criteria established in this review work. Conclusions: There are orthodontic/orthopedic devices aimed at solving the characteristics of class II sagittal malocclusions, but before planning early treatment it is essential to provide an accurate diagnosis to evaluate the specific type of appliance that is required.

Does daily wear time of Twin Block reliably predict its efficiency of class II treatment?

PURPOSE: The objective of this study was to investigate how daily wear time (DWT) influences class II malocclusion treatment efficiency. MATERIALS AND METHODS: The study group consisted of 55 patients (mean age 10.4 years) diagnosed with a class II/1 malocclusion. Twin block appliances, with built-in Theramon® microsensors (MC Technology, Hargelsberg, Austria) to monitor patients' cooperation (daily wear time assessment), were used for treatment. Cephalograms were taken and the following initial and final measurements were compared: Co-Gn, Co-Go, Co-Olp, Pg-Olp, WITS, SNA, SNB, ANB, Co-Go-Me, overjet, molar and canine relationships. The Shapiro-Wilk test, Wilcoxon signed-rank test, Student's t-test, Levene's test, Mann-Whitney U test, Kruskal-Wallis test, χ2 test, and Spearman's rank correlation coefficient with p < 0.05 set as the statistical significance level were used to determine the correlation of the outcomes with DWT; a ROC (receiver operating characteristic) curve was calculated to illustrate diagnostic ability of the binary classifier system. RESULTS: DWT was very highly positively correlated with change of the Pg-Olp parameter and highly with an improvement in the ANB, SNA, and SNB angles, an increase in the WITS parameter and an increase in Co-Gn distance. DWTs < 7.5 h correlated with significantly less improvement of the investigated variables. However, DWT > 7.5 h did not significantly correlate with the improvement of the overjet and most of the linear parameters in the mandible. The ROC curve and its AUC (area under curve) allowed the determination of a DWT of 7 h and 48 min to be capable of establishing a class I relationship with 83% probability. CONCLUSIONS: Class II treatment efficiency was influenced by DWT; an 8 h threshold value had an 83% probability of establishing a class I relationship.

Elásticos intermaxilares no tratamento de má oclusão Classe II divisão 1 ­ um enfoque clínico / Intermaxillary elastics in the treatment of Class II division 1 maloclusion ­ a clinical approach

Resumo As más oclusões têm etiologia multifatorial, são causadas por fatores ambientais e genéticos. Dentre os tipos de más oclusões existentes tem-se a Classe ll, que geralmente se caracteriza pela protrusão de dentes superiores, retrusão de dentes inferiores, prognatismo maxilar ou retrognatismo mandibular. Com o passar dos anos, os elásticos intermaxilares foram sendo desenvolvidos e melhorados, com isso houve um aumento em sua aplicabilidade na Ortodontia. Existem diversas situações clínicas em que se pode utilizar os elásticos, no entanto o profissional precisa entender seus riscos e limitações. Este artigo apresenta um relato de caso sobre o tratamento para Classe II com o uso de elásticos intermaxilares, cuja mecânica é de fácil manuseio e baixo custo.(AU)

Abstract Malocclusions have a multifactorial etiology, they are caused by environmental and genetic factors. Among the existing types of malocclusions there is Class II, which is generally characterized by upper teeth protrusion, lower teeth retrusion, maxillary prognathism or mandibular retrognathism. Over the years, intermaxillary elastics have been developed and improved, thus, there has been an increase in their applicability in Orthodontics. There are several clinical situations in which we can use elastics, however, the professional needs to understand their risks and limitations. This article presents a case report on the treatment of Class II with the use of intermaxillary elastics, whose mechanics are easy to handle and of low cost. (AU)

Camuflagem ortodôntica na correção da má oclusão de Classe II divisão 1ª de Angle, utilizando-se o aparelho de protração mandibular associado à técnica MEAW ­ relato de caso / Orthodontic camouflage in correction of Class II division 1 Angle malocclusion, using mandibular protraction appliance associated with MEAW technique ­ case report

Resumo O objetivo deste trabalho é relatar um caso clínico de camuflagem ortodôntica de má oclusão de Classe II divisão 1ª com retrognatismo mandibular através do Aparelho de Protração Mandibular (APM) e da técnica Multiloop Edgewise Archwire (MEAW). A paciente de 16 anos e 8 meses de idade, tinha como queixa principal o retrognatismo mandibular. No exame clínico, foi verificado o perfil convexo, incisivos superiores vestibularizados, sobremordida e sobressaliência acentuadas, mandíbula retrognática e má oclusão de Classe II divisão 1ª. O APM foi utilizado simultaneamente à técnica MEAW para camuflagem da Classe II. Ao final do tratamento, foi obtida uma melhora no perfil facial, oclusão com sobremordida e sobressaliência normais e boa intercuspidação. O APM e a técnica MEAW demonstraram eficácia na camuflagem ortodôntica da má oclusão de Classe II divisão 1ª com retrognatismo mandibular. (AU)

Abstract The objective of this work is to report a clinical case of orthodontic camouflage of Class II division 1 malocclusion with mandibular retrognathism using the Mandibular Protraction Appliance (MPA) and the Multiloop Edgewise Archwire (MEAW) technique. The female patient, 16 years and 8 months old, had as main complaint mandibular retrognathism. In the clinical examination, convex profile, buccal upper incisors, increased overbite and overjet, retrognathic mandible, and Class II division 1 malocclusion were verified. MPA was used simultaneously with the MEAW technique for Class II camouflage. At the end of the treatment, an improvement in facial profile, occlusion with normal overbite and overjet, and good intercuspation were obtained. MPA and the MEAW technique demonstrated effectiveness in orthodontic camouflage of Class II division 1 malocclusion with mandibular retrognathism. (AU)

Long term dental transversal stability of Class II division 1 treated with cervical headgear

ABSTRACT Introduction: In several conditions, outcome stability is a great challenge for Orthodontics. Previous studies have reported that relapse commonly occurs along the years after orthodontic treatment finishing. Objective: The aim of the present study was to evaluate in the long-term transversal dental arch changes of Class II division 1 patients treated with cervical headgear and fixed appliance. Methods: Plaster study casts of 20 patients treated with cervical headgear without dental extractions were 3D-scanned and evaluated in three distinct times: initial (T1), immediate post-treatment (T2) and long-term retention (T3 - minimum 20 years). Transversal teeth distance of maxillary and mandibular canines, premolars and first molars were measured. Results: A statistically significant increase during treatment was observed for all maxillary teeth transversal distances (p< 0.05). In turn, a significant reduction was observed in the long term (p<0.05). For the mandibular teeth, canine transversal distance presented statistically significant constriction in the retention period (p<0.05). Mandibular first molars distance was significantly expanded by treatment (p<0.05) and remained stable in the long term. The changes observed for the other teeth or other times were considered not statistically relevant. Conclusions: For the accessed sample, transversal changes occurred during treatment and retention phases in Class II division 1 patients treated with cervical headgear and fixed appliance. Relapse was considered statistically relevant, even with the institution of a retention protocol.

RESUMO Introdução: Em várias condições, a estabilidade dos resultados é um grande desafio para a Ortodontia. Estudos prévios relataram que a recidiva ocorre, comumente, ao longo dos anos, após o término do tratamento ortodôntico. Objetivo: O objetivo da presente pesquisa foi avaliar as alterações transversais da arcada dentária em longo prazo de pacientes Classe II, divisão 1, tratados com aparelho extrabucal cervical e aparelho fixo. Métodos: Modelos de gesso de 20 pacientes tratados com AEB cervical, sem extrações dentárias, foram escaneados e avaliados em três momentos distintos: inicial (T1), pós-tratamento imediato (T2) e acompanhamento de longo prazo (T3, mínimo de 20 anos). A distância transversal entre os caninos superiores e inferiores, pré-molares e primeiros molares foi medida. Resultados: Foi observado aumento estatisticamente significativo durante o tratamento para todas as distâncias transversais dos dentes superiores (p < 0,05). Por sua vez, foi observada redução significativa em longo prazo (p < 0,05). Para os dentes inferiores, a distância transversal intercaninos apresentou constrição estatisticamente significativa no período de contenção (p < 0,05). A distância dos primeiros molares inferiores aumentou significativamente com o tratamento (p < 0,05) e permaneceu estável em longo prazo. As alterações observadas para os outros dentes ou outros tempos foram consideradas sem significância estatística. Conclusões: Para a amostra estudada, as alterações transversais ocorreram durante as fases de tratamento e contenção em pacientes Classe II, divisão 1, tratados com aparelho extrabucal de tração cervical e aparelho fixo. A recidiva foi considerada estatisticamente significativa, mesmo com a instituição de um protocolo de contenção.

Nuevas opciones de aparatos funcionales para tratar pacientes con retrognatismo mandibular / New functional appliance options for treating patients with mandibular retrognathia

RESUMEN Fundamento: El estudio sobre los aparatos actuales de la ortopedia funcional de los maxilares puede aportar nuevos conocimientos para el perfeccionamiento del tratamiento de pacientes con retrognatismo mandibular. Objetivo: Profundizar en los nuevos aparatos de la ortopedia funcional de los maxilares para el tratamiento de pacientes con retrognatismo mandibular. Desarrollo: Se realizó una revisión bibliográfica en las bases de datos SciELO, PubMed, Ebsco, Cumed y Lilacs. En la búsqueda se revisaron 37 artículos, de ellos más del 80 % son de los últimos cinco años. Se identificaron bases teóricas de la ortopedia funcional de los maxilares en el tratamiento de pacientes con retrognatismo mandibular y los aparatos que se utilizan en la actualidad. Conclusiones: Existen nuevas opciones de aparatos funcionales, en su mayoría fijos y clasificados como dentosoportados pasivos, para el tratamiento de pacientes con retrognatismo mandibular.

ABSTRACT Background: The study of the current jaw functional orthopedic appliances can provide new knowledge for the improvement of the patients' treatment with mandibular retrognathia. Objective: To study deeply the current jaw functional orthopedic appliances for the patients' treatment with mandibular retrognathia. Development: A bibliographic review was conducted in the SciELO, PubMed, Ebsco, Cumed and Lilacs databases. A total of 37 articles were reviewed, more than 80 % from the last five years. Theoretical bases on the jaw functional orthopedics in the patients' treatment with mandibular retrognathia and current appliances in use were identified. Conclusions: New functional appliance options, mostly fixed and classified as passive dent supportive, are available for the patients' treatment with mandibular retrognathia.

Effects of Angle class II correction with the Forsus fatigue resistant device on mandibular third molars : A retrospective study.

PURPOSE: The goal was to evaluate the effects of Angle class II malocclusion treatment using the Forsus fatigue resistant device (FRD, 3M, St. Paul, MN, USA) on the position and angulation of mandibular third molars and retromolar space. PATIENTS AND METHODS: In all, 58 class II patients (mean age 13.6 ± 1.8 years) treated with the FRD (FRD group) were compared with 51 class I patients (mean age 13.5 ± 1.6 years) who underwent orthodontic treatment (control group). A total of 109 mandibular third molars in the FRD group and 91 in the control group were evaluated. Changes in the retromolar space, angulation of the second (É£) and third molars (ß), and the angle between these teeth (α) were assessed with panoramic radiographs taken at the beginning and the end of the treatment. Data were statistically analyzed. RESULTS: At the end of the treatment, there were significant increases in É£ and ß in the FRD group and É£ in the control group (p < 0.05). The decrease in α in the FRD group and increase in the control group were not significant (p > 0.05); however, this change led to a small significant change between the groups (p < 0.05). The retromolar space significantly increased in the FRD group compared to the control group (p < 0.05). No significant correlation was found between retromolar space and third molar uprighting in any of the groups (p > 0.05). CONCLUSION: Class II correction with FRD led to mesialization of the lower arch which provided an increase in the retromolar space. Little improvement in the uprighting of the third molars occurred.

Comparison of Tooth Widths, Arch Widths and Arch Lengths in Class-I Normal Dentition to Class-I and II Crowded Dentitions.

BACKGROUND AND OBJECTIVE: Dental study casts play a vital role in the diagnosis and treatment planning of various orthodontic cases. This study was carried out to compare the tooth widths, arch widths, and arch lengths in Class-I normal dentition to those in Class-I and Class-II crowded dentition in an effort to improve treatment planning and to eventually reduce treatment duration. METHODS: Total 170 patients, 12 to 40 years of age with a complete set of permanent teeth till 1st molars; who presented to the Orthodontics Department at Armed Forces Institute of Dentistry (A.F.I.D), Rawalpindi from Sep 2019 to Feb 2020, were included in the study. Non-probability purposive method of sampling was used. The dental casts obtained were used to measure tooth widths, arch widths, and arch lengths. Subjects were classified into Class-I normal and Class-I and Class-II crowded occlusion and comparison of the sum of tooth widths, arch widths, and arch length discrepancies were determined among the three occlusion groups. Data was analyzed in SPSS version 21 and independent samples t-test was used to differentiate the variables of interest. RESULTS: Out of 170 subjects, 73 (42.9%) subjects had Class-I normal occlusion while 97 (57%) had Class-I and Class-II crowded occlusions. No statistical difference was found between the occlusal groups with regard to the sum of tooth widths, inter-canine widths, inter-first premolar widths, inter-second premolar widths and inter-molar widths. However, a remarkable difference was observed between the occlusal groups with respect to arch perimeters and arch length discrepancies (p = 0.000 and 0.000 respectively). CONCLUSIONS: Results of the current study indicate that crowding of teeth occurs as a consequence of decreased arch perimeters which may lead to increased arch length discrepancies. However, no prominent difference was noticed in the sum of tooth widths and arch widths among different occlusal groups.

Correção da má oclusão de classe II com propulsor mandibular: revisão de literatura / Correction of class II malocclusion with mandibular trusters: literature review

Introdução: a má oclusão de classe II consiste no desequilíbrio da relação entre as arcadas, podendo ser causada por deficiência mandibular, protrusão maxilar, ou ambas, sendo caracterizada pelo molar inferior distalmente posicionado em relação ao molar superior. Objetivo: este estudo tem o objetivo de apresentar uma revisão de literatura sobre a eficiência dos propulsores mandibulares fixos disponíveis no mercado odontológico no tratamento da má oclusão de classe II. Métodos: a pesquisa foi realizada nas bases de dados Google Acadêmico, SciELO e PubMed, para filtragem dos artigos selecionados. Para revisão de literatura, foram utilizados 17 artigos. Entre os protocolos de tratamento de classe II, esses aparelhos se destacam por serem fixos, por esse motivo, não dependem da colaboração direta do paciente. Com o passar dos anos, os propulsores mandibulares fixos foram cada vez mais aprimorados, oferecendo mais simplicidade na sua instalação e maior conforto ao paciente. Considerações finais: concluiu-se que os aparelhos funcionais propulsores mandibulares fixos são uma ótima escolha para o tratamento compensatório na má oclusão de classe II, sendo eficazes na correção da relação dentária e dependendo de menor cooperação do paciente.(AU)

Introduction: class II malocclusion consists of an imbalance in the relationship between the arches, which can be caused by mandibular deficiency, maxillary protrusion, or both, and is characterized by the mandibular molar distally positioned in relation to the maxillary molar. Objective: this study aims to present a literature review on the efficiency of fixed mandibular thrusters available in the dental market in the treatment of Class II malocclusion. Methods: the research was carried out in the Google Scholar, SciELO and PubMed databases to filter the selected articles. For literature review, 17 articles were used. Among Class II treatment protocols, these devices stand out for being fixed, for this reason, they do not depend on the direct collaboration of the patient. Over the years, fixed mandibular thrusters have been increasingly improved, offering more simplicity in their installation and greater comfort to the patient. Final considerations: it was concluded that the fixed mandibular thrusters functional devices are a great choice for compensatory treatment in Class II malocclusion, being effective in correcting the dental relationship and depending on less patient cooperation.(AU)

Effect of cervical headgear on dental arch area, shape and interarch dimensions : A randomized study.

PURPOSE: The goal was to study the effects of early cervical headgear treatment on maxillary and mandibular dental arch area, shape and interarch dimensions. METHODS: The total study group comprised 67 children aged 7.6 years (standard deviation 0.3) with Angle class II malocclusion collected between 1992 and 1996. The children were randomly divided into two groups of equal size. In the first group, cervical headgear treatment was started immediately and undertaken for 2 years. The remaining patients served as untreated controls. Dental casts were taken and scanned at the beginning of treatment (T0) and at the 2­year (T1) and 4­year follow-up (T2). Three-dimensional landmarks describing the positions of maxillary and mandibular incisors, canines, first and second premolars and first molars were used to calculate and visualize the maxillary and mandibular dental arch area and shape using the polynomial equation y = Ax6 + Bx2. RESULTS: Significant changes in the shape and area of both maxillary and mandibular dental arches were induced with cervical headgear. The headgear increased dental arch area, sagittal dimensions at the mid-sagittal line and transversal dimensions at all of the measured levels in both dental arches compared to the control group. CONCLUSIONS: Cervical headgear is an effective treatment device to gain space in both dental arches. Furthermore, when used as an early phase treatment, relapse is relatively small compared to the gained space.

Management of skeletal class II malocclusion using bimaxillary skeletal anchorage supported fixed functional appliances : A novel technique.

AIM: To evaluate the treatment effects in growing skeletal class II patients subjected to a novel treatment technique, i.e., bimaxillary miniplates supported fixed functional appliance. The null hypothesis was that there is no statistically significant difference in skeletal changes of patients with class II malocclusion treated with bimaxillary skeletal anchorage supported fixed functional appliance and those who were not provided any intervention. METHODS: The sample comprised 32 skeletal class II subjects (17 males and 15 females) with a Cervical Vertebrae Maturity Index (CVMI) demonstrating peak of pubertal growth spurt. Sixteen patients (12.37 ±1.09 years of age) were treated with bimaxillary skeletal anchorage supported fixed function appliance, while 16 well-matched subjects (12.06 ± 1.34 years of age) were included as controls. For both groups, cephalograms (T1, T2) were taken with a matched observational interval of about 7.5 months; 17 linear and 10 angular measurements were recorded. The intraclass correlation coefficient (ICC) was used to determine reliability of measurements recorded. Student t test was carried out to determine the changes produced by the treatment relative to control. RESULTS: When compared with the control group, the treatment group demonstrated significant maxillary retrusion. No significant changes were seen in mandibular growth pattern, whereas mandibular length increased significantly more than in the control group (B-VP: 3.05 mm; Co-Gn: 2.65 mm). Treatment mechanics had minimal effects on maxillary dentition. Mandibular incisors proclined by an average of 3.06°. Maxilla-mandibular relation improved significantly (ANB: -4.29°; NA-Pog: -3.76°). CONCLUSION: The new bimaxillary skeletal anchorage supported fixed functional appliance technique was found to be highly effective in the treatment of class II malocclusion with significant skeletal changes.

Skeletally anchored forsus fatigue resistant device for correction of Class II malocclusions-A systematic review and meta-analysis.

The use of skeletal anchorage with fixed functional appliances (FFA) has been proposed by various authors to produce skeletal changes and reduce lower incisor proclination. To compare the skeletal and dentoalveolar effects of Forsus Fatigue Resistant Device (FFRD) with or without skeletal anchorage (miniplates and mini-implants). The electronic database PubMed, Cochrane Library, Medline, Embase and Google Scholar along with a manual search of orthodontic journals till the year 2019. Only randomized control trials (RCTs) were included in the systematic review. One controlled clinical trial (CCT) which involved FFRD was included in the review since it was a continuation of an RCT which was expanded to a CCT. Skeletal and dentoalveolar outcome data were extracted to collect study characteristics. After evaluating risk of bias, the standardized mean differences (SMDs) and 95% confidence intervals (CIs) were calculated. Three RCTs and one prospective CCT were evaluated. The analysis included data from 116 Class II subjects [(58) treated with FFA along with skeletal anchorage and (58) treated with FFA]. There were no significant difference between the two groups with respect to mandibular length changes (P value = .10) and SNB angle changes (P value = .22). With respect to lower incisor inclination however, there was a significant difference between the two groups (P value = .005) signifying better results with respect to skeletal anchorage. The studies reviewed provide insufficient evidence to form a conclusion regarding the effects of the use of skeletal anchorage with FFRD. The available weak evidence suggests that the use of skeletal anchorage with FFRD has no superior skeletal effects but is able to reduce proclination of the lower incisors. Control of lower incisor proclination remains the most significant advantage of skeletal reinforcement, and miniplate-anchored FFRD showed more promising results in preventing lower incisor proclination than miniscrew-anchored FFRD.

Percepção dos Cirurgiões-Dentistas sobre o diagnóstico e manejo de pacientes portadores de maloclusão de Classe II Esquelética / Perception of Dental Surgeons on the diagnosis and management of patients with Skeletal Class II malocclusion

A compreensão de características dentoesqueléticas e faciais são imprescindíveis para o correto diagnóstico e tratamento ortodôntico. Quanto ao período correto de intervenção, o tratamento precoce se justifica para evitar o traumatismo dentário, desgastes dentários e a preservação da auto-estima da criança dentro da sociedade. Desta forma o trabalho tem por objetivo avaliar a percepção dos Cirurgiões-Dentistas sobre o diagnóstico, época ideal e tipos de tratamento da maloclusão de Classe II Esquelética, através de um artigo científico, realizado por meio de um questionário eletrônico para Cirurgiões-Dentistas (n=315), distribuído por meio de e-mail, Instagram e Facebook, constituído de 22 perguntas, determinando características sócio-demográficas, grau de percepção dos participantes, bem como época ideal e tipos de tratamentos para a maloclusão de Classe II Esquelética. Os dados foram tabulados no Programa Statistical Package for the Social Science (SPSS) versão 20.1 para Windows. Na verificação da normalidade da amostra, aplicou-se o teste ShapiroWilk, para comparação entre os grupos, foi realizado o teste T, o teste de regressão logística binária foi aplicado para mensurar o grau de relação e comportamento entre as variáveis quantitativas estudadas, o teste Qui-Quadrado e/ ou Exato de Fisher fora utilizado em busca de possíveis associações, foram consideradas associações positivas em presença de p valor <0,05. Sendo verificado que a maior parte dos entrevistados foram Odontopediatras (n=41,66% ± 9,82), gênero feminino (n=42,23 % ± 9,70) com média de idade (n=42,04% ± 9,09), oriundos da região Sudeste (n= 42,28% ± 9,58) que exerciam atividade clínica no serviço privado (n=42,30% ± 9,87). Não houve associação estatisticamente significativa em relação a auto-percepção de diagnóstico e o real conhecimento à respeito da maloclusão de Classe II Esquelética (p>0,05) em todas as especialidades perguntadas, exceto na especialidade Ortodontia. Para auxiliar a compreenção do diagnóstico da maloclusão de Classe II Esquelética, época de tratamento e tipos de mecanoterapia, foi criado um folheto explicativo no programa Canva.com, baseado em uma revisão de literatura sobre os assuntos acima, dentro da base de dados Med Line (via Pub Med e Web of Science). Além disto, foi realizado um relato de caso clínico sobre o tratamento precoce da maloclusão de Classe II Esquelética de uma criança de 6 anos e 8 meses tratada com disjunção maxilar e sequência de alinhadores (Invisalign®), objetivando a propulsão mandibular e a melhora da relação esquelética e de oclusão. Observou-se que o tratamento ortodôntico foi capaz de reduzir o overjet, melhorar as inclinações axiais individuais dentárias, atenuar o perfil esquelético, melhorar as funções estomatognáticas alteradas juntamente com ações interdisciplinares, assim como trouxe satisfação estética para a paciente e sua família. (AU)

An understanding of dentoskeletal and facial features are essential for correct diagnosis and orthodontic treatment. As for the correct period of intervention, early treatment is justified to avoid dental trauma, tooth wear and the preservation of the child's self-esteem within society. Thus, the work aims to assess the perception of dentists about the diagnosis, ideal time and types of treatment of Class II Skeletal Malocclusion, through a scientific article, carried out through an electronic questionnaire for dentists ( n=315), distributed through email, Instagram and Facebook, consisting of 22 questions, determining socio-demographic characteristics, degree of perception of the participants, as well as ideal time and types of treatments for Class II Skeletal Malocclusion . Data were tabulated in the Statistical Package for Social Science (SPSS) version 20.1 for Windows. To verify the normality of the sample, the Shapiro-Wilk test was applied to compare the groups, the T test was performed, the binary logistic regression test was applied to measure the degree of relationship and behavior between the quantitative variables studied, the Chi-Square and/or Fisher's Exact test had been used in search of possible associations, positive associations were considered in the presence of p value <0.05. It was verified that most respondents were pediatric dentists (n=41.66% ± 9.82), female (n=42.23 % ± 9.70) with mean age (n=42.04% ± 9 .09), from the Southeast region (n= 42.28% ± 9.58) who exercised clinical activity in the private service (n=42.30% ± 9.87). There was no statistically significant association regarding self-perception of diagnosis and real knowledge about Skeletal Class II Malocclusion (p>0.05) in all specialties asked, except for Orthodontists. To help understand the diagnosis of Class II Skeletal Malocclusion, time of treatment and types of mechanotherapy, an explanatory leaflet was created on the Canva.com program, based on a literature review on the above subjects, within the Med database Line (via Pub Med and Web of Science). In addition, a clinical case report was carried out on the early treatment of Class II Skeletal Malocclusion in a child aged 6 years and 8 months treated with maxillary disjunction and sequence of aligners (Invisalign®), aiming at mandibular propulsion and improvement of the skeletal relationship and occlusion. It was observed that orthodontic treatment was able to reduce overjet, improve individual dental axial inclinations, attenuate the skeletal profile, improve altered stomatognathic functions together with interdisciplinary actions, as well as bringing aesthetic satisfaction to the patient and her family. (AU)

Tratamento em duas fases do padrão II com má oclusão de Classe II, divisão 1 por protrusão maxilar / Treatment in two stages of pattern II with Class II, division 1 malclusion by maxillary protrusion

Resumo Objetivo: realizar uma revisão da literatura sobre o tratamento do Padrão II por protrusão maxilar e má oclusão Classe II divisão 1, suas diferentes possibilidades de abordagem e apresentar um relato de caso em duas fases. Métodos: As bases de dados BIREME, Google Academic e Pubmed foram utilizadas para obtenção de artigos em Inglês e Português. Como estratégia de busca, usou-se os termos booleanos AND, AND NOT e OR para ordenar as palavras-chave e delimitar o objeto de estudo. Resultados: Verificou-se na literatura que o tratamento em duas etapas pode ser realizado com o dispositivo splint maxilar na dentição mista, para abordagem da protrusão maxilar. Na sequência, no período da dentadura permanente jovem, o aparelho autoligado como dispositivo para refinamento da oclusão estática e funcional. Conclusão: A abordagem da má oclusão de Classe II no Padrão II por protrusão maxilar pode ser realizada em duas fases, fato corroborado pelo sucesso do tratamento realizado e pela literatura avaliada neste estudo. (AU)

Abstract Objective: to carry out a literature review on the treatment of Pattern II for maxillary protrusion and Class II division 1 malocclusion, its different possibilities of approach and to present a case report in two phases. Methods: The BIREME, Google Academic and Pubmed databases were used to obtain articles in English and Portuguese. As search strategy, we have used the terms boolean AND, AND NOT and OR to order the keywords and delimit the object of study. Results: It was found in the literature that two-phase treatment can be performed with the maxillary splint device in the mixed dentition to approach the maxillary protrusion. Then, in the period of young permanent denture, the appliance is self-ligating as a device for refining static and functional occlusion. Conclusion: The approach to Class II malocclusion in Pattern II by maxillary protrusion can be performed in two phases, a fact corroborated by the success of the treatment performed and by the literature evaluated in this study. (AU)

Correlação entre maturidade dentária e índice de massa corporal em pacientes com má oclusão de Classe II / Correlation between dental maturity and body mass index in Angle Class II patients

Resumo Objetivo: Avaliar a correlação entre o Índice de Massa Corporal (IMC) e o desenvolvimento dentário em pacientes portadores de má oclusão de Classe II. Materiais e Métodos: Tratou-se de um estudo retrospectivo com uma amostra de 37 pacientes portadores de má oclusão de Classe II, que estavam em tratamento ortodôntico. Os dados idade, gênero, peso e altura foram coletados dos prontuários, juntamente com a tomada tomográfica inicial. O desenvolvimento dentário foi avaliado pelo método de Demirjian et al. (1973). O coeficiente de correlação de Pearson foi utilizado para determinar a força de correlação entre as variáveis. A significância estatística considerada foi p <0,05 bicaudal. Resultados: A amostra foi constituída por pacientes entre 10 e 16 anos. A maioria dos pacientes (78,4%) apresentou IMC dentro da normalidade. Observou-se correlação fraca sem significância estatística entre o desenvolvimento dentário e o IMC nos pacientes avaliados (r=-0,10; p=0,55). Conclusão: Não houve correlação entre o IMC e o desenvolvimento dentário para a amostra estudada (AU)

Abstract Objective: To evaluate the correlation between the Body Mass Index (BMI) and dental development in patients with Class II malocclusion. Materials and Methods: This was a retrospective study with a sample of 37 patients presenting Class II malocclusion, who were undergoing orthodontic treatment. The age, gender, weight and height data were collected from the medical records, together with the initial CT scan. Dental development was assessed using the method of Demirjian et al. (1973). Pearson's correlation coefficient was used to determine the correlation strength between variables. The statistical significance considered was p <0.05 two-tailed. Results: The sample consisted of patients between 10 and 16 years old. The majority of the patients (78.4%) had a normal BMI. There was a weak correlation without statistical significance between tooth development and BMI in the evaluated patients (r=-0.10; p=0.55). Conclusion: There was no correlation between BMI and dental development for the sample studied.(AU)

O tratamento compensatório da Classe II e mordida aberta esquelética com bráquetes autoligados ­ relato de caso / Compensatory treatment of Class II and skeletal open bite with selfligating brackets ­ case report

Resumo A maloclusão de Classe II pode ser de origem dentária, esquelética ou a combinação de ambas e está presente em aproximadamente 60% dos pacientes que procuram tratamento ortodôntico corretivo. Paciente Padrão II facial necessita muitas vezes de descompensação dentária associada à cirurgia ortognática para correção das bases ósseas. Com o uso cada vez mais frequente do sistema autoligado na Ortodontia, o número de pacientes que tiveram indicação de extração como parte do seu tratamento diminuiu consideravelmente. O tratamento compensatório tem como objetivo minimizar com movimentos dento-alveolares as deformidades esqueléticas presentes. Este trabalho relata através de caso clínico, a eficiência do sistema autoligado em paciente Padrão II, sem extrações, com metas terapêuticas expansionistas em associação ao uso de elásticos de Classe II. Devido à rejeição do paciente à cirurgia ortognática, o tratamento compensatório resultou na camuflagem das discrepâncias esqueléticas através do sistema autoligado. Apesar da indicação cirúrgica, o tratamento compensatório apresentou movimentações dentárias significativas, resultando em sucesso do tratamento com considerável melhora facial. (AU)

Abstract Class II malocclusion can be dental, skeletal or a combination of both and is present in approximately 60% of patients seeking corrective orthodontic treatment. Facial Pattern II patient often needs dental decompensation associated with orthognathic surgery to correct the bone bases. With the increasing use of the self-ligating system in Orthodontics, the number of patients who were indicated for extraction as part of their treatment has decreased considerably. Compensatory treatment aims to minimize skeletal deformities with dento-alveolar movements. This paper reports through a clinical case, the efficiency of the self-ligating system in Pattern II patient without extractions with expansionist therapeutic goals in association with the use of Class II elastics. Due to the patient's rejection of orthognathic surgery, the compensatory treatment resulted in the camouflage of the skeletal discrepancies through the self-ligating system. Despite the surgical indication, the compensatory treatment presented significant dental movements, resulting in treatment success with considerable facial improvement (AU)