Class II Malocclusion, Division 2 Treated with Forsus FRD EZ2

Summary

Introduction: Class II malocclusion, division 2, is characterized by retroclined upper incisors (11 and 21), proclined lateral incisors (12 and 22), a deep bite of 100% or more, and in some patients, a trapped mandible, in addition to hypertonic perioral musculature.

Clinical Case: A 14-year-old female patient presents for consultation, whose priority is to improve the position of her teeth and her facial profile.

Diagnosis: Class II malocclusion, division 2, with a horizontal overbite of 5 mm and a vertical overbite of 100%, square arch shape, maxillary protrusion, mild crowding in both dental arches, deepened mentolabial sulcus, convex facial profile.

Treatment Plan: This report proposes the use of the Forsus FRD EZ2 from 3M. For this, a system of bonded ceramic brackets MBT 0.022” was placed for the correction of a class II division 2.

Results: The treatment objectives were achieved at 20 months. This allows us to evaluate this mechanism as another therapeutic option for young patients.

Introduction

The prevalence of class II dental malocclusions in the Latin population ranges from 20.64% to 44.1%, which is a high percentage compared to other malocclusions.

The choice of treatment depends on several factors, the most important of which is the young age of the patient. Treatments vary widely, ranging from the use of orthopedic appliances for class II, extractions of 2 premolars, the use of a unimaxillary or bimaxillary fixed class II corrector, the use of interradicular or extraalveolar mini screws, to orthognathic surgery.

Removable or fixed class II correctors are appliances used to correct class II malocclusion. When adequate results are not achieved with orthopedic appliances, many clinicians resort to a fixed appliance where patient cooperation is significantly reduced, and therefore, some have been more successful than others; this is the case with the Forsus FRD EZ2 from 3M, which is a fixed intermaxillary corrector that has a telescopic internal mechanism and a spring around it that compresses and produces a force of approximately 230 grams per side, generating 2 force vectors, one mesial propulsive intradental and the other distal or distalizing.

It is recommended to activate 2 mm per month until the treatment goals are reached and to maintain the results.

Clinical Case

14-year-old female patient who presents for consultation with the aim of improving the position of her teeth and her facial profile. Prior to filling out the orthodontic clinical history, the parents signed the informed consent.

Diagnosis

Upon questioning her personal medical history, she reports being healthy, with no history of surgeries or diseases: psychosocially, she appears stable and centered.

An assessment of her basic diagnostic elements was conducted, finding a convex facial profile, moderate brachyfacial biotype, and asymptomatic TMJ. (Figure 1).

In the intraoral analysis and cephalometric tracing, a class II malocclusion, division 2, with a horizontal overbite of 5 mm, square-shaped upper dental arches, skeletal pattern I, and no mutually protected occlusion is observed (Figure 2-5).

Treatment

The recommendation based on the patient's age was a conservative approach, without extractions and the use of the fixed Class II corrector, Forsus FRD EZ2. (Figure 6).

Initially, the MBT ceramic bracket system 0.022 was placed, starting with the first phase of treatment. (Figure 7).

In the leveling stage, the distance was measured from the distal of the upper first molar to the midpoint between the canine and lower premolar, choosing the size of 29 mm.

Subsequently, it was inserted into the tube of the extraoral arch of the upper molar and the push rod was placed between the canine and the lower premolar on both sides and began its work of distalizing both upper quadrants. (Figure 8).

The activation of the mechanism was every 30 days, 2 mm with a gurin stop that moves distally in the lower rectangular arch 0.017X0.025” Nitinol, with 4 activations and a retention of 90 days with a 0.020” Australian arch with mesial stops at the 6s tubes.

Once the result of a class I molar and canine was obtained; the anterior spaces are closed with arches with a post 0.019X0.025” and type 3 retrobands. (Figure 9).

Finally, the results are contained with a 0.019X0.025” Braided steel arch, a gingivectomy from 13 to 23 is performed, a fixed lower loop retainer from 3-3 and a removable upper from 7-7 is used. (Figure 10).

Results

The fixed Class II corrector achieved the goal of distally moving the upper right and left quadrants and obtaining a Class I molar and canine, with correct horizontal and vertical overbite, coordination of the dental arches, achieving a mutually protected occlusion, reducing maxillary dentoalveolar protrusion, and improving the patient's soft tissues, balanced profile, and an aesthetic smile, with a treatment time of 20 months (Figure 11—14) (Table 1).

Discussion

The results obtained in this clinical case were effective in correcting Class II, division 2 to a Class I Dental, functionally and aesthetically favorable for the patient, as reported by Chaqués A J. On the other hand, a bimaxillary dentoalveolar change was also observed as reported by Tapia M., achieving the orthodontic objectives, improving the facial profile, and fulfilling the priorities of the patient and her parents.

Authors: Franco Fonseca-Esparza, Khiabet Fonseca-Esparza, Franco Fonseca-Balcazar

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