PowerScope a Class II corrector - A case report

Skeletal and dental effects of a new compliance-free appliance, the NET3 corrector, in management of skeletal Class III malocclusion compared to rapid maxillary expansion-facemask

OBJECTIVES

To examine retrospectively the short-term effects of a compliance-free skeletal Class III corrector (NET3-corrector) compared to rapid maxillary expansion-facemask (RME-FM).

MATERIAL AND METHODS

Records of 20 skeletal Class III patients treated with the NET3-corrector were compared to 20 patients treated with RME-FM, mean age: 11.14 ± 1.17 years and 11.14 ± 2.06, respectively. The NET3-corrector consisted of a hybrid-expander, a lower lingual arch, and a modified PowerScope spring. The RME-FM group received an RME-facemask combination. T2 records were collected when an overjet of at least 2 mm was achieved. Differences between two timepoints within groups and differences between groups were tested using paired samples t-test and independent samples t-test, respectively (P < .05 was considered statistically significant).

RESULTS

The treatment time was 10.5 months with NET3-corrector and 12 months with RME-FM. The NET3-corrector was well tolerated by patients and the Class III malocclusion was corrected in all patients in both groups. The overall maxillary skeletal change was greater with the NET3-corrector, with an additional 2° advancement at SNA (P < .001). Significant differences in maxillary incisor angulation were observed in the RME-FM group in comparison to NET3 (-0.37 ± 3.31 vs 4.96 ± 3.80; P < .001). The mandibular molars tipped significantly more distally in the NET3 group (7.3° more; P < .001).

CONCLUSIONS

The compliance-free tooth-bone-borne NET3-corrector, is effective in correcting Class III malocclusion with improved maxillary skeletal outcomes compared to RME-FM in the short term. These results need to be evaluated in the long term with a randomized sample.

"Sagittal First" Approach Using Carriere Motion 3D Appliance: A Case Report

Aim

To present a case with skeletal class II malocclusion and mandibular retrusion treated using Carriere Motion Appliance (CMA).

Background

Management of class II malocclusion in adolescent patients by growth modulation is one of the most debated topics in orthodontics. Fixed functional appliances are generally used in the patients who are at the end of the postpubertal growth spurt. However, most of the fixed functional appliances are placed only after the initial alignment and leveling, which takes up considerable duration of time. The Carriere Motion 3D is an efficient and effective way of correcting the sagittal component of class II malocclusion within the first half year of treatment followed by comprehensive therapy using fixed appliances.

Case description

A 15-year-old male patient reported with the chief compliant of forwardly placed upper front teeth and functional jaw retrusion. It was treated initially with CMA and class II elastics for mandibular advancement. Simultaneously, lower arch was bonded with MBT 0.022" prescription for alignment and leveling. After 6 months, class I molar and canine relationship was achieved before proceeding with full orthodontic treatment. After 12 months of fixed orthodontics, the treatment goals were achieved.

Conclusion

Carriere Distalizer appears to be more comfortable, offer a more positive overall experience, and has fewer side effects. The changes were mainly dentoalveolar in nature, but there were some skeletal changes, particularly in the sagittal and vertical dimensions.

Clinical significance

A significant forward displacement of the mandible was the principal element for successful correction of class II malocclusion. CMA provides the best results for class II management, enabling us to treat such cases with a nonextraction approach rather than contemplating extractions.

How to cite this article

P SD, Ahmed N, Urukalan H, et al. "Sagittal First" Approach Using Carriere Motion 3D Appliance: A Case Report. Int J Clin Pediatr Dent 2024;17(4):490-496.

A Comparative Analysis of Treatment Effects of PowerScope and AdvanSync2 in Class II Division 1 Malocclusion: A Retrospective Study

INTRODUCTION

Fixed functional appliances are widely used for the treatment of retrognathic mandibles in skeletal class II malocclusion. The primary objective of the present investigation was to evaluate and compare the treatment effects induced by PowerScope (American Orthodontics, Sheboygan, WI) and AdvanSync2 (Ormco, Orange, CA). The hypothesis posited that there were no notable disparities in the therapeutic impacts of the two appliances.

MATERIALS AND METHODS

A retrospective study was undertaken involving 90 subjects with retrognathic mandibles. Group 1 was treated with AdvanSync2, group 2 received PowerScope treatment, and group 3 consisted of an untreated class II control sample. Lateral cephalograms were traced at pre-treatment (T0) and post-treatment (T1), to measure various skeletal, dental, and soft tissue parameters. The comparison between the groups was done using analysis of variance (ANOVA) and post-hoc analysis by Tukey's test.

RESULTS

Significant changes were observed in all the parameters, comparing the effects of both appliances to the control group (p < 0.05). AdvanSync2 displayed statistically significant skeletal effects on the maxilla and mandible (p < 0.05). The statistically significant differences were also seen for dental effects such as reduction in overbite and overjet. On the other hand, PowerScope exhibited effects that were not considered statistically significant on the maxilla, instead primarily manifesting dento-alveolar changes that led to a considerable reduction in overbite. In comparison to the control group, both appliances notably produced soft tissue changes.

CONCLUSIONS

Our study rejected the null hypothesis. AdvanSync2 yielded superior skeletal outcomes with greater mandibular advancement, compared to PowerScope, which exhibited enhanced dento-alveolar alterations. AdvanSync2 took less treatment time, compared to PowerScope.

Assessment of Soft Tissue, Airway Dimension and Hyoid Bone Position in Class II Patients Treated by PowerScope Class 2 Corrector

AIM

This study aims to assess the changes in the soft tissue, pharyngeal airway dimensions, and hyoid bone position in patients treated with PowerScope Class 2 corrector to correct the skeletal Class II pattern.

MATERIALS AND METHODS

This study was conducted on a sample of 20 cases diagnosed with Class II malocclusion. The lateral cephalograms were taken before (T1) and after functional appliance therapy (T2) and were traced. The outcomes were compared for the mean changes in soft tissue, airway way dimension, and hyoid bone position. The paired t-test was used for the data comparisons wherein p < 0.05 was kept for statistical significance.

RESULTS

The mean values before and after treatment for H angle, mentolabial angle, lower lip E-line, upper lip S-line, lower lip S-line, and lip strain were 19.88 ± 2.77 vs 17.13 ± 1.659, 94.09 ± 12.164 vs 101.75 ± 11.28, -2.47 ± 1.213 vs -1.38 ± 0.976, 3.99 ± 0.19 vs 2.64 ± 0.32, 9.01 ± 0.247 vs 9.43 ± 0.238, 10.24 ± 0.510 vs 10.64 ± 0.52, respectively, which were statistically significant (p < 0.05). All airway spaces (except for lower pharyngeal space) and hyoid bone parameters were significantly improved posttreatment.

CONCLUSION

The facial convexity, upper E-line, Z-angle, nasolabial angle, and lower pharyngeal space did not show statistically significant changes. The rest of the soft tissue parameters, oropharyngeal air spaces, and hyoid positioning measured in the study showed significant improvement after treatment with the PowerScope appliance in Class II patients.

CLINICAL SIGNIFICANCE

Class II malocclusion is the most common dental anomaly with a high degree of prevalence in the population. This study will help the clinician in understanding the improvement of soft tissue, airway dimension, and hyoid bone position changes on treatment with a fixed functional appliance for the correction of Class II cases, thereby ensuring the greater success of orthodontic therapy in the future.

Wnt/β-catenin signaling pathway is activated in the progress of mandibular condylar cartilage degeneration and subchondral bone loss induced by overloaded functional orthopedic force (OFOF)

Objective

To explore the role of Wnt/β-catenin signaling pathway in the pathogenesis and progression of temporomandibular joint osteoarthritis (TMJ OA) caused by overloaded force.

Materials and methods

We generated a rat model of forward mandibular extension device to induce TMJ OA by overloaded force. Condylar cartilage samples were collected at 2wk, 4wk, and 8wk after appliances were installed. Changes of the condylar cartilage and subchondral bone were evaluated by hematoxylin and eosin (HE), Safranin O and Fast Green staining (SO&FG), micro-CT, tartrate resistant acid phosphatase (TRAP) staining. The expression levels of β-catenin, COL-2, MMP3 and sclerostin (SOST) were detected by immunohistochemistry (IHC) and PCR.

Results

HE, SO&FG, micro-CT, OARSI and Mankin scores showed that the condyle cartilage layer was significantly thinner and proteoglycan loss in the overloded group. TRAP staining exhibited that the number of positive osteoclasts increased and OPG level decreased in the overload group. IHC, PCR showed that the expression of COL2 and SOST decreased, while MMP3 and β-catenin increased in the overload group.

Conclusion

Wnt/β-catenin signaling pathway is activated in the progress of mandibular condylar cartilage degeneration and subchondral bone loss induced by overloaded functional orthopedic force (OFOF)

Management of Asymmetric Mandibular Retrognathia with Differential Loading Technique: A Case Report

Class II malocclusion cases possess a constant challenge to orthodontists since time immemorial. Mandibular retrusion is the most common feature of class II malocclusion, rather than maxillary prognathism. Association of class II with asymmetry, a condition called asymmetric mandibular retrognathia (AMR), gives a tougher challenge to orthodontists for management. The following case presents effective management of AMR using differential loading technique. A young boy aged 12 years presented with mandibular retrognathia associated with facial asymmetry. He was treated with a differential force loading technique using a fixed functional appliance.

A Cephalometric Evaluation and Comparison of Skeletal, Dentoalveolar, and Soft Tissue Changes Brought about by the Forsus Fatigue Resistant Device and PowerScope Fixed Functional Appliance

Background:

Though studies have been conducted on the PowerScope, not many researches are available in the literature which compare its effects with other fixed functional appliances. Therefore, the aim of our study was cephalometric evaluation and comparison of the skeletal, dentoalveolar, and soft tissue changes brought about by the Forsus Fatigue Resistant Device and PowerScope appliance.

Materials and Methods:

Pre and Posttreatment cephalometric records of 20 patients with Class II Division 1 malocclusion treated with fixed functional appliances (Forsus Fatigue Resistant Device and PowerScope) were compared. Values of various cephalometric parameters were used to evaluate the skeletal, dental, and soft tissue changes. Wilcoxon signed-rank test (intragroup comparison) and Mann–Whitney U test (intergroup) were used to see significant differences in the parameters ( P ≤ .05).

Results:

Both the appliances were successful in correcting the Class II discrepancy. Skeletal changes were seen significantly in both the groups, though they were more in the Forsus patients. Dentoalveolar changes were predominantly seen in PowerScope patients. Also, an improvement in soft tissue profile was seen in both the groups.

Conclusion:

From our study, we concluded that the PowerScope and the Forsus Fatigue Resistant Device are equally good options for the correction of skeletal Class II malocclusion due to a retrognathic mandible, as they achieve changes in all the three aspects: skeletal, dentoalveolar and soft tissue.

Three-dimensional cone-beam computed tomography comparison of shorty and standard Class II Carriere Motion appliance

OBJECTIVES

To compare treatment effects of the standard and shorty Class II Carriere Motion appliances (CMAs) on adolescent patients.

MATERIALS AND METHODS

Fifty adolescents with Class II malocclusion formed group 1, who were treated with shorty CMA (n = 25, 12.66 ± 1.05 years), and age- and sex-matched group 2, who were treated with standard CMA (n = 25, 12.73 ± 1.07 years). Treatment effects were analyzed by tracing with Invivo software to compare pretreatment (T1) cone-beam computed tomography (CBCT) images with post-CMA (T2) CBCT images. A total of 23 measurements were compared within and between groups.

RESULTS

In groups 1 and 2, maxillary first molars showed significant distal movement from T1 to T2 (1.83 ± 2.11 mm and 2.14 ± 1.34 mm, respectively), with distal tipping and rotation in group 1 (6.52° ± 3.99° and 3.15° ± 7.52°, respectively) but only distal tipping (7.03° ± 3.45°) in group 2. Similarly, in both groups, the maxillary first premolars experienced significant distal movement with distal tipping but no significant rotation. In group 1, maxillary canines did not undergo significant distal movement. In both groups 1 and 2, mandibular first molars experienced significant mesial movement (1.85 ± 1.88 mm and 2.44 ± 2.02 mm, respectively). Group 1 showed statistically significantly less reduction in overjet and less canine distal movement with less distal tipping than group 2 (α < .05).

CONCLUSIONS

The shorty CMA achieved Class II correction similarly to the standard CMA, with less change in overjet and distal tipping movement of the maxillary canines.

MP. Comparative Evaluation of Hard-Tissue and Soft-Tissue Changes following Fixed Functional Appliance Treatment in a Skeletal Class II Malocclusion Using Forsus and PowerScope

Introduction The purpose of this study was to evaluate and compare the skeletal, dentoalveolar and soft-tissue effects of 2 fixed functional appliance; Forsus Fatigue Resistance Device (FFRD) and PowerScope appliance in treating patients with skeletal class II division 1 malocclusion.

Materials and Methods This comparative prospective two-group study included 20 patients with a mean age of 11.2 ± 1.6 years with skeletal class II malocclusion with retrognathic mandible. One group was treated with FFRD, and second group was treated with PowerScope appliance. Lateral cephalograms were evaluated at T1 (pre-functional appliance treatment)) and at T2 (postappliance treatment). Cephalometric values were calculated and assessed to evaluate skeletal, dentoalveolar and soft-tissue changes.

Results Sagittal correction of class II malocclusion appeared to be mainly achieved by dentoalveolar changes in the PowerScope group. The FFRD was able to induce both skeletal and dentoalveolar changes. A favorable influence on facial convexity was achieved by both groups. A significant increase in upper pharynx and lower pharynx dimension was seen in the PowerScope group. A statistically significant decrease in upper lip protrusion, increase in lower lip protrusion, increased nasolabial angle, and decrease in inferior labial sulcus were noted in both the groups. Lower incisors proclined more in the PowerScope group.

Conclusion Both appliances were effective in correcting class II malocclusion. Forsus had more skeletal effects on the mandible, whereas PowerScope had less skeletal effects on the mandible and more dentoalveolar effects, contributing to class II correction. Both groups showed a significant improvement in soft-tissue profile. PowerScope group showed a significant increase in airway dimensions.

The Class II Carriere Motion appliance

OBJECTIVES

To determine three-dimensional treatment changes produced by the Class II Carriere Motion appliance (CMA) in Class II adolescent patients with Class I and Class II skeletal relationships.

MATERIALS AND METHODS

The sample included 59 adolescents (16 boys and 43 girls) with unilateral or bilateral Class II molar and bilateral Class II canine relationship. They were divided into group 1 with skeletal Class I (N = 27; ANB 2.90° ± 1.40°; 13.30 ± 1.53 years) and group 2 with skeletal Class II (N = 32; ANB 6.06° ± 1.64°; 13.26 ± 1.76 years). Cone beam computed tomography images were traced with Invivo software pretreatment (T1) and post-CMA usage (T2). The treatment changes in 36 measurements were calculated in each group, and the changes in 16 measurements were compared between them.

RESULTS

In group 1 and 2, maxillary first molars underwent significant distal movement (1.92 mm ± 0.80 mm and 1.67 mm ± 1.56 mm, respectively) with distal tipping and rotation, maxillary canines underwent significant distal movement (2.34 mm ± 1.07 mm and 2.24 mm ± 1.91 mm, respectively) with distal tipping and rotation, and mandibular molars underwent significant mesial movement (-1.37 mm ± 1.23 mm and -2.51 mm ± 1.51 mm, respectively) with mesial tipping. Between the groups, there were significant differences in mandibular molar mesial movement and the U1-SN changes (P < .05).

CONCLUSIONS

The CMA corrected Class II malocclusion through distal tipping and rotational movement of maxillary canines and molars and corrected mesial tipping of mandibular molars. Significantly more mandibular molar mesial movement and maxillary incisor flaring were observed in patients with skeletal Class II.

The Evaluation and Clinical Efficiency of Power Scope: An Original Research

AIMS AND OBJECTIVES

Managing mild-to-moderate Class II malocclusion is one of the common and major challenges to orthodontists. Class II discrepancies with mandibular deficiency during active growth are usually treated using myofunctional appliances. Fixed functional appliances evolved due to the noncompliance with conventional myofunctional appliances. One of the latest Class II correctors is the PowerScope appliance. The purpose of this study was to determine the amount, time, and rate of molar correction and efficacy of PowerScope.

MATERIALS AND METHODS

A total of 10 participants, between 15 and 19 years' age group (mean = 16.8 years; 5 males and 5 females), requiring treatment of Class II malocclusion were considered for this study. All routine records were made. After initial leveling and alignment, lateral cephalogram was taken in standardized natural head position using Planmeca ProMax unit. Later, PowerScope was installed and a patient was monitored every month for further adjustment and reactivation. On achieving Class I molar relation, skeletal, dental, and soft-tissue linear and angular parameters were measured using Dolphin Imaging Software. Amount, rate, and total treatment time for molar correction were measured. Molar correction was calculated by taking S vertical as reference plane. The obtained values were statistically analyzed using paired t-test.

RESULTS

There were statistically significant changes seen in dentoalveolar parameters such as lower incisor proclination, mandibular molar advancement, and reduction in both overjet and overbite. In skeletal parameters, due to the anterior positioning of the mandible, sagittal parameters showed statistically significant changes. In the soft tissue, a significant improvement in facial profile was seen, due to the anterior movement of soft-tissue pogonion.

CONCLUSION

The results of this study have shown that statistically significant differences were found in dentoalveolar, soft-tissue, and skeletal parameters.

A Custom Made Skeletal Class II Corrector Appliance in Late Adolescent Phase

Skeletal Class II correction in deceleration phase of growth is both a challenge and dilemma with choice between extraction and myofunctional therapy. With marginal growth remaining the convenient choice is extraction for camouflage of the skeletal discrepancy. On the other hand, the treatment with Fixed Functional Appliances (FFAs) helps in resolution of the problem without sacrificing the dentition. However, the conventional FFAs requires a phase of alignment which results in further loss of time to utilize any remaining growth. The present report proposes the use of a novel custom made functional appliance for Class II skeletal correction which is simple to fabricate and convenient to use.