Forsus Group Research Articles

Effects of the Forsus fatigue-resistant device and mandibular anterior repositioning appliance in Class II malocclusion treatment

Fixed functional appliances have been used to treat Class II malocclusion by a huge number of professionals. This retrospective study aimed to analyze the effects of the Forsus fatigue-resistant device and compare the findings with a well-matched group treated with the mandibular anterior repositioning appliance (MARA). The Forsus group was composed of 14 patients at an initial mean age of 12.4 ± 1.3 years, treated with the Forsus fatigue-resistant device followed by a fixed orthodontic appliance. The MARA group comprised 18 patients at an initial mean age of 12.1 ± 1.3 years, treated with MARA followed by fixed orthodontic appliances. The untreated control group consisted of 14 patients matched with the other groups. Posttreatment changes were calculated as T1 - T2. Intergroup comparisons regarding treatment changes were performed using repeated-measures analysis of variance followed by Tukey's test. During treatment, the Forsus group showed a statistically significant decrease in maxillary protrusion and maxillomandibular sagittal discrepancy in the control group. The MARA group showed significantly greater retrusion of maxillary incisors than the Forsus and the control group. Overjet decreased significantly more in the treated groups in relation to the control group. Molar relationship improved significantly more in both treated groups, and both showed more correction than the untreated control group. The Forsus and MARA associated with fixed appliances effectively corrected the Class II malocclusion, mostly using dentoalveolar changes and maxillary growth restriction.

CBCT evaluation of changes in condylar position following fixed functional appliance therapy: A comparative in vivo study

Objective: to evaluate and compare the condylar positional changes after the treatment of class ii malocclusion patients using powerscope appliance and forsus fatigue resistant device using pre-treatment and post-treatment CBCT images.Materials and Method: twenty subjects of adult age group having class ii division 1 malocclusion, horizontal to average growth pattern, orthognathic maxilla, retrognathic mandible, increased overjet were included in this study. The subjects were divided into two groups, forsus group and power scope group. A pre-treatment cbct scan was taken before the start of the treatment using Kodak 9000 3d extraoral imaging system. In group i, forsus fatigue resistant appliance was used to achieve class i occlusion. After completion of the forsus therapy another CBCT scan was taken. In group ii, powerscope appliance was used to achieve class i occlusion. Sequential activation of the powerscope appliance was done using crimpable shims depending on the amount of skeletal discrepancy in each patient’s mouth, until edgeto-edge bite was obtained. After completion of the powerscope appliance therapy, another CBCT scan was taken. After the pre and post treatment CBCT scans were analyzed, position of the condyle were assessed on the dicom images, using the cs 3d imaging software. The field of view was confined to the right and left TMJ. This was done so that condylar head, glenoid fossa and external auditory meatus were visualized and the data obtained were subjected to statistical analysis. Comparison of all the pre & post treatment parameters were done by paired-t test. Comparison of forsus and power scope group was done using independent t-test.Results: an average forward shift of mandibular condyle by. 85 mm was seen after 7- 9 months of treatment in forsus appliances therapy and. 79 mm after powerscope therapy indicating that the forward mandibular condylar shift is greater in forsus group than the powerscope group, the forward condylar shift of two groups was statistically insignificant with a mean difference of. 060 mm.Although both the forsus and powerscope groups showed a downward shift of mandibular condyle, there was a greater downward shift in forsus group (2.69 mm) compared to the powerscope group (2.29 mm), the downward condylar shift of two groups was statistically insignificant with a mean difference of 0.42mm.Conclusion: forsus appliance brought about a more anterior and downward shift in the mandibular condylar position, compared to power scope group but the difference were not statistically significant between the two appliances i.e. Forsus and powerscope.

Effect of Twin Block Therapy Versus Fixed Functional Appliances on Pharyngeal Airway Space in Skeletal Class II Patients: A Prospective Cephalometric Study.

Class II malocclusion is one of the most common malocclusion with varied prevalence. Functional therapy with appliances like Twin Block or Fixed functional appliances forms the mainstay of treatment in growing Class II patients. These patients might demonstrate narrow airway due to the retrognathic position of the mandible. This study investigated the effects of twin block and fixed functional appliance therapy (Forsus™ FRD) on the pharyngeal airway space in skeletal Class II patients. Forty patients with Class II malocclusion were selected and divided into two equal groups of 20 patients each for both Twin block and Forsus group. Lateral cephalograms were obtained before and after the functional appliance therapy. Evaluation was done for changes in hyoid bone position, pharyngeal airway dimensions and tongue position. The variables of the study showed better hyoid position in both the groups. In Twin Block group, an increase in hy-apw2 and hy-PoFH suggested anterior positioning of hyoid and a decrease in H-MP and hy-ML indicated superior positioning. In Forsus group an increase in H-H', hy-FH, hy-ML, hy-NL, hy-NSL and hy-OL suggested inferior positioning of hyoid, while an increase in hy-apw2, hy-CVT, hy-PoFH, hy-RL and hy'-tgo indicated anterior positioning of hyoid bone after functional therapy. Both the twin block and Forsus™ FRD improved the position of the hyoid bone after the functional appliance therapy however the changes were not statistically significant. Twin block and Forsus™ had similar effect on the hyoid bone position, pharyngeal dimensions and the tongue position.

Comparative Evaluation of Hyoid Bone Position and Tongue Area with Twin Block and Forsus: A Randomized Clinical Trial

Introduction: Class II div 1 malocclusion is most commonly presented with retruded mandible. This backward placement of mandible pushes the tongue posteriorly and inturn impairs the position of hyoid bone and total tongue area. Correction of retruded mandible with functional appliances is also considered to have positive effect on hyoid bone position and tongue area. Aim and Objectives: The objective of this study was to evaluate and compare the effects of Twin Block and Forsus on the hyoid bone position and tongue area in the treatment of Class II division 1 malocclusion.
 Materials & Method: A 2-arm parallel, randomized controlled trial was designed consisting of 24 Class II division 1 malocclusion patients indicated for treatment with functional appliances. 24 patients were randomized and equally divided among Twin Block (Group A) and Forsus (Group B) group. Pre- and post functional lateral cephalograms of both groups were traced and statistically analysed using paired t-test and T test of Equality of Means. ‘p’ value of less than 0.05 was considered as statistically significant.
 Result: A significantly upward and forward movement of hyoid bone was found with both the appliances. Tongue area also improved with Twin Block and Forsus group. On intergroup comparison insignificant results were observed between both the appliances indicating similar effect on tongue area and hyoid bone position.
 Conclusion: Twin Block has more skeletal effect than Forsus, still both Twin Block and Forsus are effective in improving tongue area and forward and upward displacement of hyoid bone position while correcting Class II malocclusion.

Volumetric measurements of mandibular incisor root resorption following Forsus FRD EZ2 and Bionator appliance treatment using cone-beam computed tomography: A preliminary study

Objectives: Root resorption is one of the frequently encountered problems in orthodontic treatments. The effects of functional appliances on root resorption have not been clearly demonstrated. The aim of this study was to compare volumetric root resorption of mandibular incisors after Bionator and Forsus appliance treatment using cone-beam computed tomography (CBCT). Materials and Methods: The study sample (n = 30) was selected from Class II div. 1 mandibular retrognathia patients treated with the Bionator and Forsus appliances. The first CBCT scans were taken before Bionator use and after 6 months. In the Forsus group, the first CBCT scans were taken before Forsus appliance use and after an overcorrected Class I relationship was obtained. The mean treatment time with the Forsus appliance was 5 ± 1.2 months. Mimics software was used for segmentation and volumetric measurements of mandibular incisor teeth root resorption. Results: In the Bionator group, statistically significant root volume loss was not found. In the Forsus group, the differences between before and after the treatment were not statistically significant for teeth 41, 31, and 32 (P > 0.05), whereas the difference was statistically significant for the lower right second incisor (P < 0.002). The percentage of volume loss (%) and root volume loss (mm3) was not statistically significant between groups. Conclusions: Following functional treatment with the Bionator and Forsus, statistically significant difference was not found between groups for mandibular incisor root resorption.

Comparison of 2 treatment protocols using fixed functional appliances in Class II malocclusion: Treatment results and stability

The objective of this research was to compare the 2 treatment protocols including a functional mandibular advancer (FMA; Forestadent, Pforzheim, Germany) followed by multibracket appliances (MBAs) vs a Forsus device (3M Unitek, Monrovia, Calif) in combination with MBA concerning treatment outcomes and posttreatment stability. This study was conducted using lateral cephalograms of patients who were treated with MBA, which was used either after an FMA or concurrently with a Forsus device, and of patients who had untreated Class II malocclusion (control group). Each group consisted of 19 subjects in cervical stage 2 or cervical stage 3 stages according to the cervical vertebral maturation index. Cephalograms were taken for the treated groups at T1 (pretreatment), T2 (completion of the MBA treatment), and T3 (at least 2years after T2). Significant intergroup differences at the T1-T2 period were observed in favor of the FMA concerning mandibular advancement, intermaxillary relationship, and mandibular elongation. With Forsus treatment, restrained maxillary growth and a slightly improved intermaxillary relationship rebounded after treatment (P<0.05). At the end of treatment, mandibular incisor protrusion and occlusal plane rotation were greater in the Forsus group than in the FMA group (P<0.05), and maxillary incisor retroclination was significant in the Forsus group. During the posttreatment period, although no significant changes were present in the incisors' inclination, relapses of the T1-T2 improvements in overjet and overbite and the recidive of the occlusal plane rotation were significantly higher in the Forsus group. Treatment protocol including an FMA was found to be more effective with mandibular skeletal effects and was more stable with a lesser degree of relapse in overjet and overbite than the Forsus protocol.

Dentoskeletal effects of the forsus™ fatigue resistance device in the treatment of class II malocclusion: A systematic review and meta-analysis.

OBJECTIVE:The aim of this systematic review and meta-analysis is to quantitatively compare previous studies that evaluated skeletal and dentoalveolar effects of the Forsus™ Fatigue Resistance Device (FRD) in the treatment of Class II malocclusion with a matched untreated control group.MATERIALS AND METHODS:Four electronic searches PubMed, Web of Science, Cochrane Library, and Science Direct that were limited to articles on human studies comparing the effect of Forsus appliance with a matched control group in the treatment of Class II malocclusion from the year (2000–2017). An additional manual search was carried out by examining the references of the included articles, SEARCH terms included; Forsus and Class II malocclusion. The quality of the included studies was assessed using the modified methodological score for clinical trials. The data were analyzed using Michael Borenstein's Comprehensive Meta-Analysis Software (V3.3.070, Biostat, Inc., US).RESULTS:Seven studies were included comprising 273 participants (Forsus group = 142; control group = 131). The results indicated a statistical significant skeletal effect of the Forsus appliance on increasing the occlusal plane only (P < 0.001). The results also indicated a statistical significant (P < 0.001) dentoalveolar effects of the Forsus appliance on the following outcomes; protruding, proclining, and intruding lower incisors; retroclining upper incisors, distalizing and intruding upper molars, as well as reducing overjet and overbite.CONCLUSIONS:The Forsus™ showed positive effects on the maxillary incisors and first molars as well as overjet and overbite. However, multiple negative effects were reported on the occlusal plane and lower incisors that need to be considered when using such appliance in treating Class II malocclusion.

Letters From Our Readers.

We would like to thank Drs Xiaolong Li and Wenli Lai for their interesting questions. It is true that the treatment sequencing was different in the Forsus and Twin Block groups. However, skeletal maturity with the CVM method was evaluated at the beginning of the phase of mandibular advancement. Contrary to what we wrote, skeletal maturity in the Forsus group actually was evaluated on lateral cephalograms that were available when the Forsus appliance was mounted on fixed appliances and not at the start of fixed appliance therapy (T1). Therefore, there was a good matching between the two groups in terms of skeletal maturity at the beginning of the phase of mandibular advancement. Beside the issues of treatment timing or treatment sequencing, we think that the lack of significant mandibular skeletal modification in the Forsus group might have been due to the short duration of active Forsus treatment (on average, less than 6 months). We thank Drs Xiaolong Li and Wenli Lai for providing the opportunity to clarify these important issues.

Letters From Our Readers.

We would like to thank Drs Xiaolong Li and Wenli Lai for their interesting questions. It is true that the treatment sequencing was different in the Forsus and Twin Block groups. However, skeletal maturity with the CVM method was evaluated at the beginning of the phase of mandibular advancement. Contrary to what we wrote, skeletal maturity in the Forsus group actually was evaluated on lateral cephalograms that were available when the Forsus appliance was mounted on fixed appliances and not at the start of fixed appliance therapy (T1). Therefore, there was a good matching between the two groups in terms of skeletal maturity at the beginning of the phase of mandibular advancement. Beside the issues of treatment timing or treatment sequencing, we think that the lack of significant mandibular skeletal modification in the Forsus group might have been due to the short duration of active Forsus treatment (on average, less than 6 months). We thank Drs Xiaolong Li and Wenli Lai for providing the opportunity to clarify these important issues.

Three-dimensional effects of the mini-implant-anchored Forsus Fatigue Resistant Device: A randomized controlled trial.

To detect three-dimensionally the effects of using mini-implant anchorage with the Forsus Fatigue Resistant Device (FFRD). The sample comprised 43 skeletal Class II females with deficient mandibles. They were randomly allocated into three groups: 16 patients (13.25 ± 1.12 years) received FFRD alone (Forsus group), 15 subjects (13.07 ± 1.41 years) received FFRD and mini-implants (FMI group), and 12 subjects (12.71 ± 1.44 years) were in the untreated control group. Three-dimensional analyses of cone beam computed tomographic images were completed, and the data were statistically analyzed. Class I relationship and overjet correction were achieved in 88% of the cases. None of the two treatment groups showed significant mandibular skeletal effects. In the FMI group, significant headgear effect, decrease in maxillary width, and increase in the lower facial height were noted. In the FMI group, retroclination of maxillary incisors and distalization of maxillary molars were significantly higher. Proclination and intrusion of mandibular incisors were significantly greater in the Forsus group. FFRD resulted in Class II correction mainly through dentoalveolar effects and with minimal skeletal effects. Utilization of mini-implant anchorage effectively reduced the unfavorable proclination and intrusion of mandibular incisors but did not produce additional skeletal effects.

Comparison of Forsus FRD EZ and Andresen activator in the treatment of class II, division 1 malocclusions

Purpose of this study is to evaluate the effects of Forsus Fatigue-Resistant Device (FRD) EZ and Andresen activator in terms of skeletal, dental, and soft tissue changes in actively growing patients presenting with class II, division 1 malocclusion. Study sample included 60 subjects. Inclusion criteria were as follows: class II division 1 malocclusion, retrognathic mandible, normal or low-angle growth pattern, and peak growth period. The first study group consisted of 20 patients who were treated with Forsus appliance, and the second group of 20 patients received treatment with Andresen activator. Control group received no treatment. Our results revealed that both appliances enhanced mandibular growth, helped increase the length of the mandible, and had a restraining growth effect on the maxilla. Anterior face height increased in both of treatment groups, whereas posterior face height had a significant increase in the activator group only. More mandibular incisors protrusion and intrusion were seen with the Forsus appliance. Moreover, occlusal plane and palatal plane rotated significantly in clockwise direction as a result of dentoalveolar changes only in the Forsus group. As well as the Forsus appliances corrected class II discrepancies mostly through dentoalveolar changes as compared to the activator group, both appliances proved effective in the treatment of growing individuals having class II malocclusions with mandibular retrognathia. By this investigation, two treatment methods, which are currently used in clinical practice, will be evaluated, and the results will be useful for clinicians.

Class II Non-Extraction Patients Treated with the Forsus Fatigue Resistant Device Versus Intermaxillary Elastics

To evaluate the Forsus Fatigue Resistant Device (FRD) as a compliance-free alternative to Class II elastics. A sample of 34 (14 female, 20 male) consecutively treated nonextraction FRD patients (12.6 years of age) were matched with a sample of 34 (14 female, 20 male) consecutively treated nonextraction Class II elastics patients (12.2 years of age) based on four pretreatment variables (ANB, L1-GoMe, SN-GoMe, and treatment duration). Pretreatment and posttreatment cephalometric radiographs were traced and analyzed using the pitchfork analysis and a vertical cephalometric analysis. t-Tests were used to evaluate group differences. Group differences were evaluated using t-tests. No statistically significant differences were found in the treatment changes between the groups. There was a general trend for mesial movement of the maxilla, mandible, and dentition during treatment for both groups. The mandibular skeletal advancement and dental movements were greater than those in the maxilla, which accounted for the Class II correction. Lower incisor proclination was evident in both groups. Vertically, the maxillary and mandibular molars erupted during treatment in both groups, while lower incisors proclined. With the exception of lower molar mesial movements and total molar correction, which were significantly (P < .05) greater in the Forsus group, there were no statistically significant group differences in the treatment changes. The Forsus FRD is an acceptable substitute for Class II elastics for noncompliant patients.

Longitudinal study of facial growth in relation to skeletal maturation during adolescence

The objective of this research was to compare the 2 treatment protocols including a functional mandibular advancer (FMA; Forestadent, Pforzheim, Germany) followed by multibracket appliances (MBAs) vs a Forsus device (3M Unitek, Monrovia, Calif) in combination with MBA concerning treatment outcomes and posttreatment stability.This study was conducted using lateral cephalograms of patients who were treated with MBA, which was used either after an FMA or concurrently with a Forsus device, and of patients who had untreated Class II malocclusion (control group). Each group consisted of 19 subjects in cervical stage 2 or cervical stage 3 stages according to the cervical vertebral maturation index. Cephalograms were taken for the treated groups at T1 (pretreatment), T2 (completion of the MBA treatment), and T3 (at least 2 years after T2).Significant intergroup differences at the T1-T2 period were observed in favor of the FMA concerning mandibular advancement, intermaxillary relationship, and mandibular elongation. With Forsus treatment, restrained maxillary growth and a slightly improved intermaxillary relationship rebounded after treatment (P <0.05). At the end of treatment, mandibular incisor protrusion and occlusal plane rotation were greater in the Forsus group than in the FMA group (P <0.05), and maxillary incisor retroclination was significant in the Forsus group. During the posttreatment period, although no significant changes were present in the incisors' inclination, relapses of the T1-T2 improvements in overjet and overbite and the recidive of the occlusal plane rotation were significantly higher in the Forsus group.Treatment protocol including an FMA was found to be more effective with mandibular skeletal effects and was more stable with a lesser degree of relapse in overjet and overbite than the Forsus protocol.