Early orthodontic treatment of Class II malocclusions with no-compliance appliances: study project with Forsus device system

Aim: Class II malocclusion is considered as a sagittal discrepancy between the maxillary bases characterized by a protrusion of the maxilla and/ or a retrusion of the mandible. There are several therapeutic approaches where the most suitable choise depends, for example, on the different level of patient’s cooperation. During childhood, the most used appliances for Class II malocclusion are the removable functional devices that need a good patient’s cooperation to be successful. The aim of this study was to evaluate the dental-alveolar and skeletal effects of an interceptive orthodontic treatment with a mandibular propulsive orthodontic appliance named Forsus in Class II growing patients with lack of compliance for functional appliances. Methods: A group of growing patients was selected to be treated with Forsus device following inclusion and exclusion methods. Some inclusion methods were: Class II malocclusion, OVJ more than 4 mm, stage of vertebral development Cs2-Cs3, lack of compliance for functional appliances. Some exclusion methods were though: permanent dentition, stage of vertebral development Cs4, presence of temporary mandibular disorders. The device wasn’t associated with a multibrackets orthodontic therapy but it presented a new design studied to be applied in mixed dentition. The telescopic system of Forsus device, that consists of a pushrod inside a Ni-Ti spring, was combined with a palatal arch and a double mandibular ferule. The upper and lower first molars presented orthodontic bands. The telescopic system connected the maxilla to the mandible from distal to mesial having contact, respectively, with the vestibular tubes of the upper first molars and with the mesial stops located in the vestibular sides of the mandibular ferule, at the level of the interproximal zone between canine and first deciduous molar or first premolar. A first patient was chosen to be treated to evaluate the effectiveness of the therapy with this new design, to underline both strengths and weaknesses of the therapy. A complete photographic intraoral record was carried out before installation of Forsus device as well as during the different stages of the treatment. Cephalometric radiograph analysis was taken before therapy and at the completion of comprehensive therapy. A comparison between initial and final digital study models was as well realized. The treatment lasted 8 months. Results: The overall therapeutic effects were mainly dento-alveolar while the skeletal effects were less significant as a slight improvement of ANB angle from 7,7° to 5,4°. The overjet decreased significantly from 7,1 mm to 3,2 mm and the overbite from 4,5 to 0,1. A new molar relationship of Class 1 of Angle was achieved. Conclusion: Forsus device is a valid option of no- compliance interceptive orthodontic treatment in Class II growing patients. Although the therapy had mainly dento-alveolar effects, it will be possible to achieve more skeletal effects for example taking care to apply the device for the whole period of the peak of growth.