Dentoalveolar Structures Research Articles

Analysis of dentoalveolar structures with novel corticotomy-facilitated mandibular expansion: A 3-dimensional finite element study.

Surgically assisted mandibular arch expansion is an effective treatment modality for alleviating constriction and crowding. However, only mandibular symphyseal osteotomy is recommended for mandibular arch expansion. No relevant studies have compared the biomechanical responses of different corticotomy designs on mandibular expansion. Therefore, the aim of this study was to evaluate the effect of different corticotomy approaches and modes of loading on the expansion of adult mandibles using biomechanics. Nine finite element models including 2 novel corticotomy designs were simulated. Stress, strain, and displacement of crown, root, and bone were calculated and compared under different corticotomy approaches and loading conditions. The biomechanical response seen in the finite element models in terms of displacement on the x-axis was consistent from anterior to posterior teeth with parasymphyseal step corticotomy and tooth-borne force application. In addition, the amount of displacement predicted by parasymphyseal step corticotomy in the tooth-borne mode was greater compared with other models. These results suggest that parasymphyseal step corticotomy with tooth-borne force application is a viable treatment option for true bony expansion in an adult mandible.

Periodontal disease-like bone loss after ?adjuvant radiotherapy in the head and neck region: ?A case report and review of the literature.

The purpose of this study was to present a rare case of periodontal disease-like bone loss and possible treatment options. This paper discusses the pros and cons of conservative treatment and radical surgical intervention and summarizes possible complications. It focuses also on the individual situation of the patient and provides a review of literature. A 32-year-old patient presented with widening of the periodontal spaces and apical translucencies at every tooth after adjuvant radiotherapy of an oral squamous cell carcinoma (OSCC) of the tongue. In addition, the patient suffers from slight mental retardation. The following periodontal parameters were examined: Bleeding Index, Plaque Index, tooth mobility, and clinical attachment loss. Panoramic radiography and computed tomography were used for diagnosis and follow-up purposes. The literature review was carried out systematically combined with individual searching. This study presents a distinct case of rarely mentioned periodontal-disease-like bone loss, most likely radiation-induced. This resulted in complete devitalization of the entire dentition and will eventually lead to a loss of all teeth. The review of the literature summarizes the incidence of post-radiogenic periodontitis, bone loss, and possible risk-factors of unwanted events after radiotherapy in the oral cavity and dentoalveolar structures. The combination of the patient's history and individual situation makes this a special case with regard to decision making and further therapy. After carefully considering the possible options, a conservative treatment with minimal surgical interventions and close surveillance was followed. The intention was the preservation of the patient's natural dentition as long as possible as well as the prevention of an osteonecrosis of the jaw. Taking the literature review into account this article presents a patient with an unusually distinct extent of periodontal disease-like bone loss, which is not to be compared to periodontal disease.

Health-Related Quality of Life and the Desire for Revision Surgery Among Children With Cleft Lip and Palate.

Children with cleft lip with or without palate (CLCP) require multiple reconstructive procedures, however, little is known about their desire for surgical revision. The purpose of this study was to examine the relationship between health-related quality of life (HRQOL) and the desire for revision. The authors surveyed children with CLCP (n = 71) and their caregivers regarding general and cleft-specific HRQOL and the desire for revision surgery. The authors used logistic regression models to evaluate the relationship between HRQOL and the desire for revision stratified by age, and determined the level of agreement between caregivers and children. In this cohort, 54.9% of children desired revision, primarily of the nose (n = 23), lip (n = 20), and dentoalveolar structures (n = 19). Children 11 years or older were more likely to desire revision than younger children (OR 3.39, 95% CI [1.19, 9.67], P <0.05). Children who reported poorer HRQOL with respect to appearance (OR 2.31, 95% CI [1.25-4.29], P = 0.008), social development (OR 0.91, 95% CI [0.84-0.99], P = 0.02), and communication (OR 0.94, 95% CI [0.89-0.99], P = 0.02) were significantly more likely to desire revision than children who reported more positive HRQOL. Caregivers' and children's desires for revision were only modestly correlated (r = 0.41). Children with CLCP who report poorer HRQOL are more likely to desire revision than children with higher HRQOL; these differences are further magnified among older children. Given the modest correlation between patient and caregiver goals for revision, it is important to evaluate both perspectives when considering revision surgery.

Stress distribution on maxillary central incisorunder similar traumatic situations with different loading forces: a 3-D finite element analysis.

Aim: The present study aimed to analyze the stress distribution in the dentoalveolar structures of a maxillary central incisor submitted to two situations of impact loading. Materials and Methods: The following loading forces were applied using a three-dimensional finite element model: a force of 500 N at an angle of 45° on the buccal surface of the crown and a 2000 N force acting in the same direction and surface of the tooth. Results: Harmful stress was observed in the second situation, suggesting damage to both the tooth and adjacent tissue. However, the damage found in soft tissues such as dental pulp, was negligible. Conclusion: Injuries resulting from the traumatic situations were more damaging to the integrity of the tooth and its associated hard-tissue structures. Uniterms: Tooth injuries. Finite element analysis. Biomechanics. Computing methodologies. Threedimensional imaging.

Cephalometric evaluation of the effects of the Twin Block appliance in subjects with Class II, Division 1 malocclusion amongst different cervical vertebral maturation stages.

ABSTRACTObjectives: To evaluate the cephalometric changes in skeletal, dentoalveolar and soft tissue variables induced by Clark's Twin Block (CTB) in Class II, Division 1 malocclusion patients and to compare these changes in different cervical vertebral maturation stages.Methods: Pre- and post-treatment/observation lateral cephalograms of 53 Class II, Division 1 malocclusion patients and 60 controls were compared to evaluate skeletal, dentoalveolar and soft tissue changes. Skeletal maturity was assessed according to cervical vertebral maturation stages. Pre- and post-treatment/observation mean changes and differences (T2-T1) were compared by means of Wilcoxon sign rank and Mann-Whitney U-tests, respectively. Intergroup comparisons between different cervical stages were performed by means of Kruskal-Wallis test and Mann-Whitney U-test (p ≤ 0.05) .Results: When compared with controls, there was a significant reduction in ANB angle (p < 0.001), which was due to a change in SNB angle in CS-2 and CS-3 (p < 0.001), and in SNA (p < 0.001) and SNB (p = 0.016) angles in the CS-4 group. There was significant increase in the GoGn-SN angle in CS-2 (p = 0.007) and CS-4 (p = 0.024), and increase in Co-Gn and Go-Gn amongst all cervical stages (p < 0.05). There was significant decrease in U1-SN and increase in IMPA amongst all cervical stages (p < 0.05). There was significant retraction of the upper lip in CS-3 (p = 0.001), protrusion of the lower lip in CS-2 (p = 0.005), increase in nasolabial angle in CS-4 (p = 0.006) and Z-angle in CS-3 (p = 0.016), reduction in H-angle in CS-2 (p = 0.013) and CS-3 (p = 0.002) groups. When pre- and post-treatment mean differences were compared between different cervical stages, significant differences were found for SNA, SNB and UI-SN angles and overjet. .Conclusions: The Twin-Block along with the normal craniofacial growth improves facial esthetics in Class II, Division 1 malocclusion by changes in underlying skeletal and dentoalveolar structures. The favorable mandibular growth occurs during any of the cervical vertebral maturation stages, with more pronounced effect during CS-3 stage.

Deterioration of teeth and alveolar bone loss due to chronic environmental high-level fluoride and low calcium exposure.

Health risks due to chronic exposure to highly fluoridated groundwater could be underestimated because fluoride might not only influence the teeth in an aesthetic manner but also seems to led to dentoalveolar structure changes. Therefore, we studied the tooth and alveolar bone structures of Dorper sheep chronically exposed to very highly fluoridated and low calcium groundwater in the Kalahari Desert in comparison to controls consuming groundwater with low fluoride and normal calcium levels within the World Health Organization (WHO) recommended range. Two flocks of Dorper ewes in Namibia were studied. Chemical analyses of water, blood and urine were performed. Mineralized tissue investigations included radiography, HR-pQCT analyses, histomorphometry, energy-dispersive X-ray spectroscopy and X-ray diffraction-analyses. Fluoride levels were significantly elevated in water, blood and urine samples in the Kalahari group compared to the low fluoride control samples. In addition to high fluoride, low calcium levels were detected in the Kalahari water. Tooth height and mandibular bone quality were significantly decreased in sheep, exposed to very high levels of fluoride and low levels of calcium in drinking water. Particularly, bone volume and cortical thickness of the mandibular bone were significantly reduced in these sheep. The current study suggests that chronic environmental fluoride exposure with levels above the recommended limits in combination with low calcium uptake can cause significant attrition of teeth and a significant impaired mandibular bone quality. In the presence of high fluoride and low calcium-associated dental changes, deterioration of the mandibular bone and a potential alveolar bone loss needs to be considered regardless whether other signs of systemic skeletal fluorosis are observed or not.

Desenvolvimento de uma plataforma multimídia como objeto didático para compreensão dos eventos da gênese dentária

A tecnologia tem se difundido gradativamente em todas as esferas da sociedade, se estabelecendo como indispensável. No âmbito da educação não é diferente, ela vem abrindo novas portas para o desenvolvimento do conhecimento. O presente trabalho tem como objetivo descrever a, elaboração de uma plataforma multimídia sobre gênese dental e as possíveis alterações dento-alveolares que dela se originam, para que os estudantes tenham uma visão ampliada, dinâmica e interdisciplinar deste conhecimento. Como referencial teórico foram utilizados livros que servem como base no ensino da odontologia, além de buscas de artigos científicos nas bases de dados Scielo, PubMed, Periódicos CAPES, e em outras fontes de informação, como o Google Acadêmico. Para a elaboração do instrumento foi utilizado o sistema Flash + ActionScript 3 (AS3) na plataforma Adobe AIR, permitindo ao aluno a navegação em todas as fases formativas do elemento dentário à medida que clicarem no ambiente desejado. A interdisciplinaridade e interatividade dos assuntos permitidos por esta plataforma oportunizará ao discente a construir um conhecimento de alta relevância na odontologia, servindo de instrumento didático dentro da nova tendência do ensino que, consequentemente, ajudará no raciocínio da investigação do diagnóstico.

A comparison of the sagittal and vertical dentofacial effects of maxillary expansion produced by a memory screw and a hyrax screw

Abstract Aim The aim of the present study was to investigate and compare the cephalometric effects of a conventional Hyrax expansion screw and a memory screw on the skeletal and dentoalveolar structures and soft tissues of the face. Methods Thirty-two patients with a maxillary transverse deficiency were divided into two groups. A memory-screw group included 17 patients (nine females and eight males), while a Hyrax-screw group was comprised of 15 patients (eight females and seven males). The mean ages of the subjects in the memory-screw and Hyrax-screw groups were 13.00 ± 1.29 and 12.58 ± 1.50 years, respectively. Lateral cephalograms were taken of the patients at the beginning of the treatment (T1), at the end of expansion (T2) and retention periods (T3). The mean expansion period was 7.76 ± 1.04 days in the memory-screw group and 35.46 ± 9.39 days in the Hyrax-screw group. The Shapiro-Wilk Normality test was used to determine whether the investigated parameters were homogeneous. To determine the treatment changes within the groups, a paired t-test and Wilcoxon Signed Rank test were applied to the homogeneous and non-homogeneous parameters, respectively. A comparison between the groups was carried out using the Student’s t-test for homogeneous parameters and the Mann-Whitney U test for all others. Results A results summary indicates that mid-palatal sutural opening and subsequent important skeletal and dental expansions were obtained in all patients. The maxilla moved anteriorly and inferiorly in both groups while the mandible rotated inferiorly and posteriorly but to a greater extent in the memory-screw group. Conclusion The newly-developed memory expansion screw takes advantage of rapid and slow maxillary expansion protocols. The suture is opened and the maxilla expanded with relatively lighter forces over a shorter time. The RME using the memory screw resulted in similar sagittal and vertical changes to those produced by the Hyrax screw.

DİŞ HEKİMLİĞİNDE DÜŞÜK YOĞUNLUKLU KESİKLİ ULTRASON KULLANIMI

Ultrasound for diagnostic applications has a wide field of usage. As well as being used as a diagnostic tool, for therapeutic effects of ultrasound, low intensity and pulsed ultrasound is used. In recent years, lowintensity ultrasound usage has increased as supplementary treatment method especially in wound and bone healing. The effect of ultrasound on dentoalveolar structures has been attempted to enlighten by new studies. The purpose of this review is to describe the field of usage of the low intensity ultrasound

Simulation of Low-Intensity Ultrasound Propagating in a Beagle Dog Dentoalveolar Structure to Investigate the Relations between Ultrasonic Parameters and Cementum Regeneration

The therapeutic effect of low-intensity pulsed ultrasound on orthodontically induced inflammatory root resorption is believed to be brought about through mechanical signals induced by the low-intensity pulsed ultrasound. However, the stimulatory mechanism triggering dental cell response has not been clearly identified yet. The aim of this study was to evaluate possible relations between the amounts of new cementum regeneration and ultrasonic parameters such as pressure amplitude and time-averaged energy density. We used the finite-element method to simulate the previously published experiment on ultrasonic wave propagation in the dentoalveolar structure of beagle dogs. Qualitative relations between the thickness of the regenerated cementum in the experiment and the ultrasonic parameters were observed. Our results indicated that the areas of the root surface with greater ultrasonic pressure were associated with larger amounts of cementum regeneration. However, the establishment of reliable quantitative correlations between ultrasound parameters and cementum regeneration requires more experimental data and simulations.

A rare case of hemimandibular hyperplasia

Facial asymmetry, defined as a difference in the size, shape or relationship of the two sides of the face, has a high correlation with facial harmony, attractiveness and beauty. Minor asymmetries of the human skeleton are common in the general population and usually have no esthetic or functional significance. It is reported that skeletal asymmetry is found even in the most pleasing and apparently symmetrical faces. This is not observed externally because dentoalveolar structures and the facial soft tissues show compensatory changes to minimize the underlying asymmetry; however, moderate and severe asymmetries are easily noticed by the human eye. The etiologic factors that cause facial asymmetries and their underlying mechanisms are not yet completely understood. It is appropriate to classify facial asymmetries into the two basic categories of developmental or acquired asymmetries. Developmental asymmetries include agenesis, hypoplasia, hyperplasia, atrophy, hypertrophy and malpositions of the facial bony structures. Acquired asymmetries occur as a result of traumas, infections, functional shifts and tumors. Hemimandibular hyperplasia is a developmental asymmetry characterized by three-dimensional enlargement of half of the mandible. The hyperplastic side includes the condyle, condylar neck, ramus and corpus, and the anomaly terminates at the symphysis. The unilateral increase in height of the face on the affected side results in a sloping rimaoris or mouth and rotated facial appearance. The maxilla usually follows the mandible and grows downward on the affected side. As a result, the occlusal plane tilts and is at a lower level on the affected side, whereas the teeth generally remain in occlusion.

Statistical iterative reconstruction for streak artefact reduction when using multidetector CT to image the dento-alveolar structures.

When metallic prosthetic appliances and dental fillings exist in the oral cavity, the appearance of metal-induced streak artefacts is not avoidable in CT images. The aim of this study was to develop a method for artefact reduction using the statistical reconstruction on multidetector row CT images. Adjacent CT images often depict similar anatomical structures. Therefore, reconstructed images with weak artefacts were attempted using projection data of an artefact-free image in a neighbouring thin slice. Images with moderate and strong artefacts were continuously processed in sequence by successive iterative restoration where the projection data was generated from the adjacent reconstructed slice. First, the basic maximum likelihood-expectation maximization algorithm was applied. Next, the ordered subset-expectation maximization algorithm was examined. Alternatively, a small region of interest setting was designated. Finally, the general purpose graphic processing unit machine was applied in both situations. The algorithms reduced the metal-induced streak artefacts on multidetector row CT images when the sequential processing method was applied. The ordered subset-expectation maximization and small region of interest reduced the processing duration without apparent detriments. A general-purpose graphic processing unit realized the high performance. A statistical reconstruction method was applied for the streak artefact reduction. The alternative algorithms applied were effective. Both software and hardware tools, such as ordered subset-expectation maximization, small region of interest and general-purpose graphic processing unit achieved fast artefact correction.

Assessment of the impact of tongue size in patients with bimaxillary protrusion

Tongue size, posture and pressure are considered to have significant influences on the positioning of dentoalveolar structures. Based on the equilibrium theory, forward resting posture of the tongue with light force and long duration could have both a horizontal and vertical effect on teeth. Bimaxillary proclination, a malocclusion trait often seen in African descents with multifactorial etiological factors, could well be related to tongue dimensions. The aim of this study was to evaluate the relationship between tongue dimensions and bimaxillary proclination patients. One hundred selected lateral cephalometric radiographs of consecutive orthodontic patients who met the study criteria were divided into study (bimaxillary proclination with interincisal angle [I/I]< 108°) and control (normal with interincisal relationship [I/I] ≥ 108°) groups. The subjects' tongues were pre-coated with barium sulphate before radiography in order to delineate the tongue outline. Tongue dimensions and the intermaxillary space surface area were determined and analyzed using SPSS version 11 and a computer programme for epidemiological analysis. The mean tongue measurements in the bimaxillary proclination group were higher than those in the control group except for tongue proportion. These differences were statistically significant for tongue thickness, tongue length and intermaxillary space length (P < 0.05). However, there was no statistically significant difference in the tongue area and intermaxillary space area between subjects with bimaxillary proclination and a normal interincisal relationship (P > 0.05). None of the variables (tongue thickness, tongue length, intermaxillary space length, tongue area and percentage tongue proportion) could be used as predictors for interincisal relationship. Tongue length, thickness and intermaxillary space length were significantly different between the bimaxillary and normal subjects. However, none of the measured tongue variables could be used as a predictor for incisor relationship.

Comparative Study Between Two Flaps—Trapezoidal flap (TZF) and Ocshenbein-Leubke Flap (OLF) in Periapical Surgeries

The ultimate goal in surgical endodontics is not only the eradication of periapical pathosis but also preservation of periodontal tissues using suitable surgical techniques. Treatment outcomes are no longer acceptable without considering the esthetic consequences of all involved dentoalveolar structures. It is critical that incisions and tissue elevations and reflections are performed in a way that facilitates healing by primary intention. The large variety of flaps available for periapical surgeries reflects the number of variables to be considered before choosing an appropriate flap design. In this study; Ocshenbein-Leubke (OL) and trapezoidal (TZ) flaps have been compared in terms of their efficacy and comfort. Twenty patients of ASA category I, between the age group of 12-40years were randomly selected to undergo periapical surgery by utilizing one of two flaps. All the subjects were free of periodontal disease. Demographic variables were found to be statistically similar. OL flap was found to be better than TZ flap with respect to time of flap reflection, accessibility, duration of surgery and post-operative pain. The OL flap takes less time for reflection with nearly the same accessibility, less post-operative pain and less complication as compared to TZ flap. We conclude that OL flap gives better results when compared to TZ flap.

Choice of diagnostic and therapeutic imaging in periodontics and implantology

Imaging forms an integral component for diagnosis of dental and in specific periodontal diseases. To date, intra-oral radiographic techniques are the main non-invasive diagnostic aids for the detection and assessment of internal changes in mineralized periodontal tissues like alveolar bone. These analog radiographic techniques suffer from inherent limitations like: Two dimensional projection, magnification, distortion, superimposition and misrepresentation of anatomic structures. The evolution of novel imaging modalities, namely cone beam computed tomography, tuned aperture CT empowered dental researchers to visualize the periodontium three dimensionally. This improves interpretation of structural and biophysical changes, ensures densitometric assessments of dentoalveolar structures including variations in alveolar bone density, and peri-implant bone healing more precisely. This detailed review, highlights current leading edge concepts, envisions a wide range of imaging modalities which pave the way for better understanding and early intervention of periodontal diseases.

Occlusion in implant prosthodontics

Implant prosthodontics is a vast and varied field. The most crucial stage in the replacement of a missing tooth using an implant supported prosthesis is the occlusal loading of the fixture. The longevity and the success of the restoration are primarily determined by the direction and amount forces in occlusion. The quality of bone, type of implant, type of prosthesis and patient factors all play important roles in the selection of an occlusal scheme. Each patient must be treated with an individualistic approach. The guidelines for the choice of restoration or type of occlusal scheme must be customized to allow for longevity of the restoration in harmony with the health of the surrounding dentoalveolar structures. This review article encapsulates the different factors to be considered while planning implant restorations and establishing occlusal and prosthetic schemes to protect and preserve the associated oral structures.

Cone-Beam Computed Tomography as a Tool in Endodontic Detection and Diagnosis

Radiographic imaging is essential in diagnosis, treatment planning and follow-up in endodontics. The interpretation of a periapical radiograph can be confounded by various factors including the root canal anatomy, superimposition of multiple roots of a particular tooth to be treated as well as the surrounding dentoalveolar structures. As a result of superimposition, periapical radiographs reveal only limited aspects, a twodimensional (2D) view, of the true three-dimensional (3D) anatomy. These problems can be overcome by utilizing smallor limited-volume cone-beam computed tomography (CBCT) imaging techniques, which produce accurate 3D images of the teeth and surrounding dentoalveolar structures. The purpose of this paper is to review the current literature on various clinical applications, advantages and limitations of intraoperative CBCT in the field of endodontics.

Does rapid maxillary expansion induce adverse effects in growing subjects?

To assess the scientific evidence that rapid maxillary expansion (RME) causes Adverse Effects on the midpalatal suture, vertical dimension, dental and periodontal structures in growing subjects. Electronic databases were searched for articles dated through December 2011. The quality of the studies was ranked on a 13-point scale in which 1 was the low end of the scale and 13 was the high end. Thirty relevant articles were identified. The amount of midpalatal suture opening ranged from 1.6 to 4.3 mm in the anterior region and from 1.2 to 4.4 mm in the posterior region. At the end of the active phase, RME resulted in slight inferior movement of the maxilla (SN-PNS +0.9 mm; SN-ANS +1.6 mm), increased tipping of anchored teeth from 3.4° to 9.2° and bending of the alveolar bone from 5.1° to 11.3°. In the long term, RME did not modify the facial growth patterns, and no significant changes on dentoalveolar structures were observed. Of the 30 studies, 2 were medium-high quality, 8 were medium quality, and 20 were low quality. RME always opened the midpalatal suture in growing subjects. The vertical changes were small and transitory. In the long-term evaluation, an uprighting of anchored teeth was observed and periodontal structures were not compromised.

Comparison of the Effects of Rapid Maxillary Expansion and Surgically Assisted Rapid Maxillary Expansion in the Sagittal, Vertical, and Transverse Planes

Objective: The aim of this study was to evaluate and compare the effects of rapid maxillary expansion (RME) and surgically assisted RME (SARME) in the sagittal, vertical, and transverse planes. Study design: Orthodontic records of 28 patients were selected retrospectively and divided into two treatment groups. Group 1 comprised 14 patients (4 boys, 10 girls, mean age 14.2 ± 0.74 years) who had been treated with RME. Group 2 comprised 14 patients (4 boys, 10 girls, mean age 19.6 ± 2.73 years) who had been treated with SARME. Measurements were performed on lateral and posteroanterior cephalograms and dental casts obtained before (T0) and after (T1) expansion. Results: Statistically significant differences were found in soft tissue convexity angle, anterior face height, and upper nasal width in group 1, and in U1–NA length and posterior face height measurements in group 2 (P<.05). In both groups significant increases were found in interpremolar, intermolar, maxillary, and lower nasal widths and in anterior lower face height (P<.01). Statistically significant intergroup differences were found in the ANB angle (P<.05) and maxillary intercanine (P<.01) measurements. Conclusion: With both RME and SARME, successful expansion of maxillary dentoalveolar structures and nasal cavity and palatal widening were achieved. Sagittal plane effects of SARME were similar to those of RME on dental skeletal and airway measurements. Key words: Surgically assisted rapid maxillary expansion, Rapid maxillary expansion, Airway, Transverse deficiency.

Comparison of the effects of fixed and removable functional appliances on the skeletal and dentoalveolar structures

Abstract Objective: To compare and analyse the effects of activator and Forsus FRD EZ appliances in the treatment of skeletal Class II division I malocclusion. Methods: Lateral cephalograms and hand-wrist radiographs were collected from 24 Class II division I growing patients (14 females, 10 males). The patients were randomly divided into two equal groups and either treated with an activator appliance (Mean age 12.67 ± 1.24 years) or with a Forsus FRD EZ appliance (Mean age 12.31 ± 1.09 years). Pretreatment and post-treatment cephalometric radiographs were obtained, traced, superimposed and data analysed using paired t-tests and the Wilcoxon signed rank test. Results: The results demonstrated that the Forsus FRD EZ effectively corrected the Class II malocclusion, but the changes were mainly dentoalveolar. The Forsus FRD EZ appliance induced a clockwise rotation of the occlusal plane without significant alteration in the vertical facial dimension. Skeletally, maxillary growth was restricted and pogonion moved forward which improved the profile. Conclusion: The Forsus FRD EZ appliance may be an effective dentoalveolar treatment method to manage a skeletal imbalance and improve the profile in growing patients.