Part 2: Nikhilesh explores the use of class 2 elastics, myobraces, growth and success.

Conclusions from part 1 and 2

o No advantage of early treatment

o No difference in self esteem with early treatment

o 20% failure of removable class 2 appliances

o Patients prefer fixed functional appliances

Question 9 Dento-alveolar correction worth it?

· If the results are stable = yes

· Drop outs for removable appliances 19%

Question 10 Use of class 2 elastics?

· Duration to achieve overjet correction

o 6.8/12 Vs Forsus 4.5/12 Arora 2018

o Side effects of class 2 elastics

§ Extrusion and palatal tipping of Ui

§ Clockwise rotation of occlusal plane (forsus anticlockwise rotation)

Question 11 Myobraces – off the shelf appliances?

· Activator appliances is more effective than Myobrace by 1.1mm Idris 2018

· Cost-benefit analysis however favours myobraces: Cirgic 2018

Question 12 Future growth

· No consensus about future growth prediction

· Relapse is unpredictable

o Nikhilesh recommends 1 year appliance use due to:

§ Minimising subnormal growth affects

§ Time for bone to mature

§ Minimise relapse

Question 13 Criteria for success:

o Cervical Spine Maturation 3 (CM3)

o CL2 molars

o CO-GO-ME 1250  - reduced vertical component Franchi & Bacetti

References

Arora, V., Sharma, R. and Chowdhary, S., 2018. Comparative evaluation of treatment effects between two fixed functional appliances for correction of Class II malocclusion: A single-center, randomized controlled trial. The Angle Orthodontist, 88(3), pp.259-266.

Idris, G., Hajeer, M.Y. and Al-Jundi, A., 2012. Acceptance and discomfort in growing patients during treatment with two functional appliances: a randomised controlled trial. European journal of paediatric dentistry, 13(3), pp.219-224.

Franchi, L. and Baccetti, T., 2006. Prediction of individual mandibular changes induced by functional jaw orthopedics followed by fixed appliances in Class II patients. The Angle Orthodontist, 76(6), pp.950-954.