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Reverse Forsus vs. facemask/rapid palatal expansion appliances in growing subjects with mild class III malocclusions

A randomized controlled clinical study

Reverse Forsus-Apparatur vs. Gesichtsmaske/schnelle Gaumennahterweiterungsapparatur bei Heranwachsenden mit leichtgradigen Klasse-III-Malokklusionen

Eine randomisierte, kontrollierte klinische Studie

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Abstract

Purpose

To investigate the skeletal, dental, and soft tissue effects of reverse Forsus (RF; 3M Unitek, Monrovia, CA, USA) and facemask/rapid palatal expansion (FM/RPE) appliances in growing subjects with class III malocclusions.

Methods

The data of this prospective randomized controlled trial (RCT) were derived from pre- and posttreatment/observation lateral cephalograms of 45 subjects with mild class III malocclusions: group 1 (8 girls, 7 boys; mean age 10.54 years) received a FM/RPE appliance; group 2 (6 girls, 9 boys; mean age 10.49 years) received the RF appliance; and an untreated control group (7 girls, 8 boys; mean age 10.66 years) was matched to the treatment groups with regard to sagittal skeletal and dental classifications. Angular and linear measurements were evaluated using lateral cephalograms. Statistical analyses were performed by one-way analysis of variance, Kolmogorov–Smirnov test, Kruskal–Wallis, paired-samples t‑test, and Wilcoxon test, whereby p < 0.05 was accepted to be statistically significant.

Results

The intermaxillary (ANB), interdental (overjet), and sagittal lip relations in the FM/RPE and RF groups showed significant improvements compared to the control group (p < 0.05). Although the anterior and inferior traction of the maxilla was greater in the FM/RPE group compared to the RF group (p < 0.05), both treatment groups showed similar clockwise rotation of the mandible compared to the control group. While significantly more proclination of maxillary incisors occurred in the RF group compared to the FM/RPE and control groups (p < 0.05), both treatments led to significantly retroclined mandibular incisors compared to the control group (p < 0.001).

Conclusion

Both therapies led to intermaxillary and interdental improvements. The RF appliance had a limited effect on the maxilla and it mostly had dentoalveolar effects when compared to FM/RPE therapy.

Zusammenfassung

Zielsetzung

Untersucht werden sollten die skelettalen, dentalen und weichgewebigen Auswirkungen zweier Apparaturen – Reverse Forsus (RF; 3M Unitek, Monrovia, CA, USA) und Gesichtsmaske/Gaumennahterweiterung (FM/RPE) – bei heranwachsenden Patienten mit Klasse-III-Malokklusionen

Methoden

Die Daten für diese prospektive, randomisierte, kontrollierte Studie (RCT) wurden aus seitlichen Kephalogrammen vor und nach der Behandlung/Beobachtung von 45 Probanden mit leichten Klasse-III-Fehlstellungen gewonnen: Gruppe 1 (8 Mädchen, 7 Jungen; Durchschnittsalter 10,54 Jahre) erhielt eine FM/RPE-Apparatur, Gruppe 2 (6 Mädchen, 9 Jungen; Durchschnittsalter 10,49 Jahre) eine RF-Apparatur, und eine unbehandelte Kontrollgruppe (7 Mädchen, 8 Jungen; Durchschnittsalter 10,66 Jahre) war hinsichtlich der sagittalen skelettalen und zahnmedizinischen Klassifikationen an die Behandlungsgruppen angepasst. Winkel- und Längenmaße wurden anhand von lateralen Kephalogrammen ausgewertet. Statistische Analysen wurden mittels einseitiger Varianzanalyse, Kolmogorov-Smirnov-Test, Kruskal-Wallis, t‑Test für gepaarte Stichproben und Wilcoxon-Test durchgeführt, wobei p < 0,05 als statistisch signifikant akzeptiert wurde.

Ergebnisse

Die intermaxillären (ANB), interdentalen (Overjet) und sagittalen Lippenrelationen in der FM/RPE- und RF-Gruppe zeigten signifikante Verbesserungen im Vergleich zur Kontrollgruppe (p < 0,05). Zwar war die anteriore und inferiore Traktion des Oberkiefers in der FM/RPE-Gruppe größer als in der RF-Gruppe (p < 0,05), aber beide Behandlungsgruppen zeigten eine ähnliche Posteriorrotation des Unterkiefers im Vergleich zur Kontrollgruppe. Während in der RF-Gruppe im Vergleich zur FM/RPE- und zur Kontrollgruppe eine signifikant stärkere Proklination der Oberkieferschneidezähne auftrat (p < 0,05), führten beide Behandlungen zu signifikant retroklinierten Unterkieferschneidezähnen im Vergleich zur Kontrollgruppe (p < 0,001).

Schlussfolgerung

Beide Therapien führten zu intermaxillären und interdentalen Verbesserungen. Die RF-Apparatur hatte einen begrenzten Effekt auf den Oberkiefer und im Vergleich zur FM/RPE-Therapie hauptsächlich dentoalveoläre Effekte.

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Authors and Affiliations

  1. Department of Orthodontics, Faculty of Dentistry, Adıyaman University, 02240, Adıyaman, Turkey

    Mehmet Ali Yavan

  2. Department of Orthodontics, Faculty of Dentistry, Gaziantep University, Gaziantep, Turkey

    Aysegul Gulec

  3. Department of Orthodontics, Faculty of Dentistry, Yıldırım Beyazıt University, Ankara, Turkey

    Metin Orhan

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  1. Mehmet Ali Yavan
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  2. Aysegul Gulec
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  3. Metin Orhan
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Correspondence to Mehmet Ali Yavan.

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Conflict of interest

M.A. Yavan, A. Gulec and M. Orhan declare that they have no competing interests.

Ethical standards

All procedures performed in studies involving human participants or on human tissue were in accordance with the 1975 Helsinki declaration and its later amendments or comparable ethical standards. This study was approved by the ethics committee of Gaziantep University (2015/180). Written informed consent for publication was obtained from the patients or their parents/legally authorized representatives (LAR) in the case of individuals under 18.

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Yavan, M.A., Gulec, A. & Orhan, M. Reverse Forsus vs. facemask/rapid palatal expansion appliances in growing subjects with mild class III malocclusions. J Orofac Orthop 84, 20–32 (2023). https://doi.org/10.1007/s00056-021-00330-1

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