The purpose of this article is to report the management of a transmigrated mandibular canine with emphasis on saving the tooth as natural part rather than surgical removal of the transmigrated tooth. There are several treatment options proposed for impacted mandibular canines including surgical removal, exposure and orthodontic alignment, intra-alveolar tooth transplantation (surgical repositioning of a tooth in its alveolar socket) and observation. The technique, surgical repositioning of a tooth involves the surgical extraction of impacted tooth and fixation in the correct position in the dental arch after surgical preparation (correction) of the alveolar socket. It is especially valuable in cases of difficult-to-treat impaction. A repositioned tooth is better substitute than fixed or removable prostheses, and the technique is more cost effective than other methods. Patients with excellent oral hygiene should be considered as preferred candidates for surgical repositioning of tooth. Disadvantages include the invasiveness of surgery, the difficulty of projecting long term stability due to chances of root resorption and loss of gingival attachment.

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Orthodontic force elicits a biological response in the tissues surrounding the teeth, resulting in remodeling of the periodontal ligament and the alveolar bone. The force-induced tissue strain result in reorganization of both cellular and extracellular matrix, besides producing changes in the local vascularity. This in turn leads to the synthesis and release of various neurotransmitters, arachidonic acid, growth factors, metabolites, cytokines, colony-stimulating factors, and enzymes like cathepsin K, matrix metalloproteinases, and aspartate aminotransferase. Despite the availability of many studies in the orthodontic and related scientific literature, a concise integration of all data is still lacking. Such a consolidation of the rapidly accumulating scientific information should help in understanding the biological processes that underlie the phenomenon of tooth movement in response to mechanical loading. Therefore, the aim of this review was to describe the biological processes taking place at the molecular level on application of orthodontic force and to provide an update of the current literature.

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The benefits of orthodontic treatment are numerous and in most cases, the benefits outweigh the possible disadvantages. Orthodontic treatment can play an important role in enhancing esthetics, function, and self-esteem in patients. However, it carries with it the risks of enamel demineralization, tissue damage, root resorption, open gingival embrasures in the form of triangular spaces, allergic reactions to nickel, and treatment failure in the form of relapse. These potential complications are easily avoidable by undertaking certain precautions and timely interventions by both the orthodontist and the patient. The orthodontist must ensure that the patient is aware of the associated risks and stress the importance of the patient's role in preventing these untoward outcomes. The decision whether to proceed with the orthodontic treatment is essentially a risk-benefit analysis, where the perceived benefits of commencing treatment outweigh the potential risks. This article provides an overview of the iatrogenic possibilities of orthodontic treatment and the role of the patient as well as the orthodontist in preventing the associated risks.

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OBJECTIVES: A skeletal anterior open-bite is a challenging malocclusion for the orthodontist due to the difficulty and instability of correction. Treatment options for the adult patient include extractions, anterior extrusion with intermaxillary elastics, posterior intrusion using skeletal anchorage, occlusal adjustment, and orthognathic surgery. Patient compliance plays a key role in posttreatment stability. The present case report demonstrates the orthodontic treatment of an adult patient who presented with a complex open-bite malocclusion. MATERIALS AND METHODS: Treatment involved the placement of four miniscrews to assist intrusion of maxillary molars by applying posterior vertical maxillary elastics and extrusion of the anterior segments using anterior vertical interarch elastics. RESULTS: Ideal intercuspation was successfully achieved and good stability was maintained during 3 years following treatment. CONCLUSION: The intrusion of the maxillary molars with miniscrews is an interesting option in selected cases of skeletal anterior open bite. The retention protocol should be specific in these cases.

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In the present report, two techniques of space closure; two-step anterior teeth retraction (TSR) and en masse retraction (ER) were used in two adult patients who had bimaxillary protrusion and were treated with four premolar extractions and fixed orthodontic appliance therapy. Both patients had a Class I dental malocclusion and the same chief complaint, which is protrusive lips. Anterior teeth were retracted by two-step retraction; canine sliding followed by retraction of incisors with T-loop archwire in the first patient and by en masse retraction using Beta titanium alloy T-loop archwire in the second case. At the end of treatment, good balance and harmony of lips was achieved with maintenance of Class I relationships. The outcome of treatment was similar in the two patients with similar anchorage control. ER can be an acceptable alternative to the TSR during space closure since it is esthetically more acceptable. However, it requires accurate bending and positioning of the T-loop.

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The disadvantages of having orthodontic interventions both before and after orthognathic surgery include a long treatment time of 7-47 months and temporary worsening of facial appearance. Nowadays, the concept of surgery-first, followed by orthodontic treatment is applied to orthognathic surgery cases in different orthodontic centers in the world. This concept and technique is called "surgery-first-orthognathic-approach" or "surgery-first approach" (SFA) rigid fixation (skeletal anchorage system) of the bony segments and regional acceleratory phenomenon were keys to broad implementation of the SFA. This article is intended to provide an overview of SFA including indications, general and specific guidelines, different protocol variations, success rate and potential problems.

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This case report describes the treatment of a Saudi female patient, aged 13 years 8 months at the start of treatment, with a Class I bimaxillary dentoalveolar protrusion and extracted maxillary first molars. Miniscrews were placed bilaterally in the interdental space between both the upper and the lower posterior teeth. The treatment plan consisted of extraction of both lower first permanent molars, distalization of upper and lower premolars using miniscrews followed by en masse retraction of the upper and lower six anterior teeth. The active treatment period was 2 years 8 months. Arch retention was done using upper wrap-around retainer and lower fixed 3-3 retainer. The use of miniscrews helped to resolve the bimaxillary protrusion regardless of extraction pattern used.

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Canine retraction is a very important step in treatment of patients with crowding, or first premolar extraction cases. In severe crowding cases until, the canines have been distilized to relive the crowding, space to correctly align the incisors will not be available. Correct positioning of the canines after retraction is of great importance for the function, stability, and esthetics. The aim of this systematic review was to examine, in an evidence-based way, which kinds of canine retraction methods/techniques are most effective and which have the least side effects. A literature survey was performed by applying the Medline Database (Entrez PubMed) and Science Direct database covering the period from 1985 to 2014, to find out efficient ways to accomplish canine retraction. Randomized controlled trials (RCTs), prospective and retrospective controlled studies, and clinical trials were included. Two reviewers selected and extracted the data independently and assessed the quality of the retrieved studies. The search strategy resulted in 324 articles, of which 22 met the inclusion criteria. Due to the vast heterogeneity in study methods, the scientific evidence was too weak to evaluate retraction efficiency during space closure. The data so far reviewed proved that elastomeric power chains, elastic threads, magnets, NiTi coil springs, corticotomies, distraction osteogenesis, and laser therapy, all are able to provide optimum rate of tooth movements. All the methods were nearly similar to each other for retraction of canines Most of the techniques lead to anchorage loss in various amounts depending on the methods used. Most of the studies had serious problems with small sample size, confounding factors, lack of method error analysis, and no blinding in measurements. To obtain reliable scientific evidence, controlled RCT's with sufficient sample sizes are needed to determine which method/technique is the most effective in the respective retraction situation. Further studies should also consider patient acceptance and cost analysis as well as implants and minor surgeries for canine retraction.

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Aims: Objective of this retrospective study was to evaluate the treatment effects of the MGBM-System (G.B Maino, A. Giannelly, R. Bernard, P. Mura), a new intraoral device to treat Class II malocclusions with no patient cooperation by unilateral or bilateral molar distalization. Materials and Methods: A retrospective study was conducted to compare the pre-distalization and post-distalization cephalograms and dental model casts of 30 patients (15 male, 15 female) with Class II malocclusion treated with MGBM-System. Mean age at the beginning of treatment was 13.3 years (standard deviation 3.3). Angular, horizontal and vertical measurements were recorded to monitor skeletal and dental-alveolar changes. Molar movements in horizontal plane were monitored by making dental measurements on dental model casts. Results: The MGBM-System produced a rapid molar distalization and Class II relationship was corrected in 8 months ΁ 2.05, on average. The maxillary first molars were distalized of 4.14 (PTV-6 cemento-enamel junction), associated with a significant distal axis incline of 10. 5° referred to SN and a significant intrusion of 1.3 mm (PP). As for anchorage loss, the first premolar exhibited a significant mesial movement of 0.86 mm, associated with a significant mesial axis incline of 2.46°. No significative changes in either sagittal or vertical skeletal relationship were observed. Conclusion: The results suggest that the MGBM-System is an efficient and reliable device for distalizing the maxillary permanent first and second molars.

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Early treatment of scissor bite has been advocated mainly to prevent function jaw shift that can eventually lead to permanent skeletal asymmetry and temporomandibular joint pathosis. Although unilateral scissor bite is more common, most of the times, bilateral mandibular expansion is indicated. Lingual transforce appliance can be useful in such cases. This article presents a patient with unilateral scissor bite in mixed dentition with alveolar narrowing. Transforce appliance was used for scissor bite correction followed by modified twin block appliance for stabilization and settling of occlusion till the eruption of premolars. The case was finished with fixed mechanotherapy. Two years after completion of treatment, results were well maintained. Our results suggest that lingual transforce appliance along with careful management of occlusion is effective in the early management of severe unilateral scissor bite.

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The formation of white spot lesions or enamel demineralization around fixed orthodontic attachments is a common complication during and following fixed orthodontic treatment, which mars the result of a successfully completed case. This article is a contemporary review of the risk factors, preventive methods and fate of these orthodontics scars. The importance of excellent oral hygiene practice during fixed orthodontic treatment must be explained. Preventive programs must be emphasized to all orthodontic patients. Suggestions are offered in the literature for ways to prevent this condition from manifesting itself.

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There are many temporomandibular joint (TMJ) conditions that can cause orthodontic treatment instability and relapse. These conditions are often associated with dentofacial deformities, malocclusion, TMJ pain, headaches, myofascial pain, TMJ and jaw functional impairment, ear symptoms, etc., Many of these TMJ conditions can cause progressive and continuous changes in the occlusion and jaw relationships. Patients with these conditions may benefit from corrective orthodontic and surgical intervention. The difficulty for many clinicians may lie in identifying the presence of a TMJ condition, diagnosing the specific TMJ pathology, and selecting the proper treatment for that condition. This paper will discuss the most common TMJ pathologies that can adversely affect orthodontic stability and outcomes as well as present the treatment considerations to correct the specific TMJ conditions and associated jaw deformities to provide stable and predictable treatment results.

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During the 20 ^th century, functional appliances evolved from night time wear to more flexible appliances for increased day time wear to full time wear with Twin Block appliances. The current trend is toward fixed functional appliances and this paper introduces the Fixed Twin Block, bonded to the teeth to eliminate problems of compliance in functional therapy. TransForce lingual appliances are pre-activated and may be used in first phase treatment for sagittal and transverse arch development. Alternatively, they may be integrated with fixed appliances at any stage of treatment.

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The aim of this paper is to review the current literature on allergy in orthodontics and to identify the predisposing factors and the implications of the allergic reaction in the management of patients during orthodontic treatment. A computerized literature search was conducted in PubMed for articles published on allergy in relation to orthodontics. The MeSH term used was allergy and orthodontics. Allergic response to alloys in orthodontics, particularly nickel, has been extensively studied and several case reports of nickel-induced contact dermatitis have been documented. Current evidence suggests that the most common allergic reaction reported in orthodontics is related to nickel in orthodontic appliances and allergic response is more common in women due to a previous sensitizing exposure from nickel in jewellery. Studies have implicated allergy in the etiology of hypo-dontia. It has also been considered as a high-risk factor for development of extensive root resorption during the course of orthodontic treatment. This review discusses the relationship and implications of allergy in orthodontics.

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Objectives: The objective of this study is to compare the shear bond strength (SBS) of stainless steel (SS) orthodontic brackets bonded with four different orthodontic adhesives. Materials and Methods: Eighty newly extracted premolars 0 were bonded to 0.022 SS brackets (Ormco, Scafati, Italy) and equally divided into four groups based on adhesive used: (1) Rely-a-Bond (self-cure adhesive, Reliance Orthodontic Product, Inc., Illinois, USA), (2) Transbond XT (light-cure adhesive, 3M Unitek, CA, USA), (3) Transbond Plus (sixth generation self-etch primer, 3M Unitek, CA, USA) with Transbond XT (4) Xeno V (seventh generation self-etch primer, Dentsply, Konstanz, Germany) with Xeno Ortho (light-cure adhesive, Dentsply, Konstanz, Germany) adhesive. Brackets were debonded with a universal testing machine (Model No. 3382 Instron Corp., Canton, Mass, USA). The adhesive remnant index (ARI) was recordedIn addition, the conditioned enamel surfaces were observed under a scanning electron microscope (SEM). Results: Transbond XT (15.49 MPa) attained the highest bond strength. Self-etching adhesives (Xeno V, 13.51 MPa; Transbond Plus, 11.57 MPa) showed clinically acceptable SBS values and almost clean enamel surface after debonding. The analysis of variance (F = 11.85, P < 0.0001) and Chi-square (χ² = 18.16, P < 0.05) tests revealed significant differences among groups. The ARI score of 3 (i.e., All adhesives left on the tooth) to be the most prevalent in Transbond XT (40%), followed by Rely-a-Bond (30%), Transbond Plus with Transbond XT (15%), and Xeno V with Xeno Ortho (10%). Under SEM, enamel surfaces after debonding of the brackets appeared porous when an acid-etching process was performed on the surfaces of Rely-a-Bond and Transbond XT, whereas with self-etching primers enamel presented smooth and almost clean surfaces (Transbond Plus and Xeno V group). Conclusion: All adhesives yielded SBS values higher than the recommended bond strength (5.9-7.8 MPa), Seventh generation self-etching primer Xeno V with Xeno Ortho showed clinically acceptable SBS and the least amount of residual adhesive left on the enamel surface after debonding.

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Although amelogenesis imperfecta is not a common dental pathological condition, its etiological, classification, clinical and management aspects have been addressed extensively in the scientific literature. Of special clinical consideration is the frequent co-existence of amelogenesis imperfecta with the anterior open bite. This paper provides an updated review on amelogenesis imperfecta as well as anterior open bite, in general, and documents the association of these two separate entities, in particular. Diagnosis and treatment of amelogenesis imperfecta patients presenting also with anterior open bite require a lengthy, comprehensive and multidisciplinary approach, which should aim to successfully address all dental, occlusal, developmental, skeletal and soft tissue problems associated with these two serious clinical conditions.

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Aims: To determine the cephalometric norm among Bangladeshi adults and to investigate the differences in craniofacial morphology compared with Japanese and Caucasian normative data. Materials and Methods: Cephalometric radiographs were obtained from 46 Bangladeshi males (mean age 23.8 years) and 52 Bangladeshi females (mean age 24.6 years). Inclusion criteria were the following: Both parents from the same ethnic group, class-I occlusion with an arch length discrepancy less than 2 mm, overbite and overjet from 2 to 4 mm, balanced face, all teeth present except third molar, no previous orthodontic treatment, and no prosthetic replacement of teeth. Nine angular and five linear measurements were constructed for skeletal hard tissue analysis, four angular and six linear measurements for dental hard tissue analysis, and two angular and seven linear measurements for soft tissue analysis. Mean and standard deviations of measurements were determined for each gender. Polygonal chart and profilogram were made. Independent t-test was used to determine differences. Results: The present Bangladeshi population has a smaller lower face height ( P<0.01) and the antero-posterior position of the maxilla and mandible was found to be significantly ( P<0.01) more protruded compared with the Japanese and the Caucasian norms. Significantly ( P<0.01) more protruded upper incisor, less steep occlusal plane, and thinner soft tissue chin were the characteristics in Bangladeshi adults. Conclusions: Relative to the cranial base (SN), the maxillo-mandibular complex was more anteriorly placed compared with the Japanese and Caucasian adults. Further, the effective length of the maxilla and mandible was shorter compared with the Japanese and Caucasian adults. These findings should be considered carefully during orthodontic treatment planning of Bangladeshi adults.

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Objectives: The aims of this study were to determine the mean mesiodistal tooth size width and Bolton's anterior and overall ratios, find any possible sex differences, and study the frequency of tooth size discrepancies among Yemeni population and if there is a difference in tooth size between the right and left sides. Materials and Methods: 176 subjects aged 13-25 years (94 females and 82 males) with different types of malocclusions (94 Angle Class I, 37 Class II division 1, 36 Class II division 2, and 9 Class III) were included in the present study. The mean mesiodistal tooth size width and Bolton's ratios were determined. Results: The results showed that males had significantly larger teeth than females. The prevalence rates of clinically significant discrepancy greater than 2 SD were 29.53% and 14.20% in the anterior and overall tooth size ratios, respectively. Further, the results revealed that there were no significant differences in the tooth size width between right and left sides. Conclusion: The findings of the present study indicate that there was no significant difference between Bolton's ratio and that of Yemeni population.

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OBJECTIVES: Previous reports have shown that high-frequency vibration can increase bone remodeling and accelerate tooth movement. The aim of this study was to evaluate the effects of high-frequency vibration on treatment phase tooth movement, and post-treatment bone density at initiation of retention, with cone-beam computed tomography (CBCT). MATERIALS AND METHODS: Thirty patients with initial Class I skeletal relationships, initial minimum-moderate crowding (3–5 mm), treated to completion with clear aligners and adjunctive high-frequency vibration, (HFV group) or no vibration, (Control group) were evaluated. The patients were instructed to change aligners as soon as they become loose. Changes in bone density associated with orthodontic treatment were evaluated using i-CAT cone-beam computed tomography (CBCT) and InVivo Anatomage^® software to quantify density using Hounsfield units (HU) between treated teeth in 10 different regions. HU values were averaged and compared against baseline (T1) and between the groups at initiation of retention (T2). RESULTS: The average time for aligner change was 5.2 days in the HFV group, and 8.7 days in the control group (P = 0.0001). There was significant T1 to T2 increase of HU values in the upper arch (P = 0.0001) and the lower arch (P = 0.008) in the HFV group. There was no significant change in average HU values in the upper (P = 0.83) or lower arches (P = 0.33) in the control group. The intergroup comparison revealed a significant difference in the upper, (P = 0.0001) and lower arches (P = 0.007). CONCLUSION: High-frequency vibration adjunctive to clear aligners, allowed early aligner changes that led to shorter treatment time in minimum-moderate crowded cases. At initiation of retention, the HFV group demonstrated statistically significant increase as compared with pre-treatment bone density, whereas control subjects showed no significant change from pre-treatment bone density.

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Aim: To investigate the added-value of using CBCT in the orthodontic treatment method of maxillary impacted canines and treatment outcome. Materials and Methods: The sample consisted of 118 treated patients. The CBCT group (n = 58) (39 females/19 males with the mean age of 14.3 years) included those with conventional treatment records consisting of panoramic and cephalometric radiographs, intra-and extra-oral photographs, and dental casts and complemented with a CBCT scan for additional diagnostic information. The conventional group (n = 60) (31 females/29 males with mean age 13.1 years) included those with similar conventional treatment records but without CBCT imaging. Results: There were significant differences in the canine-related variables between both groups. The CBCT group had the higher level of difficulty and more severely displaced canines when compared with the conventional group. However, no significant difference was found between groups either in the number of treatment methods used or in the use of interceptive methods combined with other treatment modalities or choice of extraction versus non-extraction. In terms of treatment success and interval duration, no significant differences were found. However, treatment duration was significantly (4 months) shorter in the CBCT group compared with the conventional group (P = 0.023). Conclusion: CBCT has been used in cases with more severe symptoms of maxillary canine impaction. The use of CBCT improved the diagnostic capabilities and improved the chances of success in the more difficult cases to a level similar to that of simpler cases treated on the basis of 2D information.

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Conventional orthognathic surgery treatment involves a prolonged period of orthodontic treatment (pre- and post-surgery), making the total treatment period of 3-4 years too exhaustive. Surgery-first orthognathic approach (SFOA) sees orthognathic surgery being carried out first, followed by orthodontic treatment to align the teeth and occlusion. Following orthognathic surgery, a period of rapid metabolic activity within tissues ensues is known as the regional acceleratory phenomenon (RAP). By performing surgery first, RAP can be harnessed to facilitate efficient orthodontic treatment. This phenomenon is believed to be a key factor in the notable reduction in treatment duration using SFOA. This article presents two cases treated with SFOA with emphasis on "case selection, treatment strategy, merits, and limitations" of SFOA. Further, salient features comparison of "conventional orthognathic surgery" and "SFOA" with an overview of author's SFOA treatment protocol is enumerated.

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Objectives: The objective of this study is to assess the differences in facial profile preference among different layers of people in the United Arab Emirates. Facial profile self-awareness among the different groups was also evaluated. Materials and Methods: A total sample of 222 participants (mean [standard deviation] age = 25.71 [8.3] years, almost 80% of the participants were of Arab origin and 55% were males); consisting of 60 laypersons, 60 dental students, 60 general practitioners, 16 oral surgeons, and 26 orthodontists. Facial profile photographs of a male and female adult with straight profiles and a Class I skeletal relationship were used as a baseline template. Computerized photographic image modification was carried out on the templates to obtain seven different facial profile silhouettes for each gender. To assess differences in facial profile perception, participants were asked to rank the profiles of each gender on a scale from most to least attractive (1 [highest score] and 7 [least score]). Awareness and satisfaction with the facial appearance on a profile view was assessed using questionnaires completed by the non-expert groups. Results: The straight facial profile was perceived to be highly attractive by all five groups. The least attractive profiles were the bimaxillary protrusion and the mandibular retrusion for the male and the female profiles, respectively. Lip protrusion was more esthetically acceptable in females. Significant differences in perception existed among groups. The female profile esthetic perception was highly correlated between the expert groups (P > 0.05). Overall agreement between the non-expert group's perceptions of their own profiles and evaluation by the expert orthodontist was 51% (κ = 0.089). Candidates who perceived themselves as having a Class III facial profile were the least satisfied with their profile. Conclusions: Dental professionals, dental students, and laypersons had a similar perception trends in female and male aesthetic preference. Laypersons were more tolerant to profiles with bi-maxillary retrusion. The expert group's esthetic perception was highly correlated only for the female profiles. Most of the non-experts were unable to correctly identify their facial profile.

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Background: A review of literature indicates the Arab cephalometric pattern compared to the Caucasian cephalometric pattern is skeletally bimaxillary retrusive, dentally bimaxillary protrusive, and more divergent palatal and mandibular planes. Objective: The aim of this study was to clarify the cephalometric features of Emirates adults with Class I malocclusion and pleasing soft tissue profile and to evaluate for gender differences. The null hypothesis tested was no differences in lateral cephalometric measurements as a function of gender. Materials and Methods: The lateral cephalometric radiographs of adult Emirati nationals with Class I malocclusion were analyzed in order to characterize an indigenous Class I malocclusion population in the United Arab Emirates. Lateral cephalometric radiographs of 30 males with average age of 24.52±6.09 years and 31 females averaging 23.57±5.52 years were analyzed using Dolphin Imaging software. Twenty-two hard and soft tissue measurements comprised the cephalometric analysis. Results: Only one gender difference was demonstrated out of the 22 cephalometric analysis measurements used in the study; SN-PP mean for females (10.74±3.44 degrees) subjects averaged a 2.3 degree higher mean value than the males (8.43±3.95 degrees, P=0.018). The cephalometric study results were compared to published norms from Steiner and Eastman. Conclusions: Based upon the conditions of the present study, it may be concluded that adult Emirati males and females seeking orthodontic treatment with Class I malocclusion present similar cephalometric profiles with the exception that measurement SN-PP may be steeper in females than males. Moreover, Emiratis are likely to present greater incisor proclination and protrusion than Caucasians and may be generally considered as more bimaxillary protrusive.

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Objective: The aim of this cross-sectional study was to compare craniofacial growth among operated and unoperated unilateral cleft lip and palate non-syndromic subjects. Materials and Methods: A sample of 180 subjects of Indian origin was selected. Of them, 90 were operated, and 90 were unoperated complete unilateral cleft lip and palate individuals. The subjects were divided into three age groups of 3-5, 8-10, and 20-25 years comprised of 30 patients in each group. The following measurements were evaluated: Angle and length of the cranial base; maxillary spatial positioning and length; mandibular spatial positioning; morphology and length; maxillomandibular relationship. Comparative analysis of the means between the groups was performed with Student's t-test at the significance levels of 5%. The ANOVA test has been performed to test the effect of time. Results: No significant differences were observed between the measurements that represented the angle and length of the cranial base of unoperated and the operated patients (P>0.05). There was statistically significant decrease ( P˂0.05) in the maxillary length (Co-A; 69.00 mm in 3-5 years, 68.33 mm in 8-10 years, and 67.17 mm in 20-25 years age group), and SNA angle (74.83Ί in 3-5 years, 74.17 Ί in 8-10 years and 73.17 Ί in 20-25 years age group) in operated group. No significant difference noticed on cephalometric values of the mandible, except Ar-Go-Me angle ( P˂0.05), which showed vertical growth pattern in unoperated patients (132.50 Ί in 3-5 years, 132.00 Ί I 8-10 years and 138.33 Ί in 20-25 years age group). Conclusion: Lip and palate repair has a significant influence on the maxilla and resulting in retarded growth of maxilla, which causes midface deficiency beyond acceptable sagittal limits. The Gonial angle showed vertical growth pattern in unoperated patients, but the cranial base angle and length of unoperated and the operated patients were similar.

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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^TM 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^TM 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.

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