Functional treatment of skeletal Class II malocclusion using bone-anchored devices and intermaxillary elastics

Introduction: Dentofacial functional appliances used for the treatment of skeletal Class II malocclusion are divided into two groups: Removable appliances and fixed (bonded) appliances, each with certain advantages and disadvantages. Considering the problems related to functional appliances such as high volume in the oral cavity, patient noncompliance, esthetics, tissue irritation or ulceration, speech or breathing difficulties, etc., there is considerable demand to develop a new appliance that can overcome these issues. Thus, the aim of the current study is to present a hypothesis regarding a new functional treatment technique. The hypothesis: We hypothesize that by fixing mini-plates or -implants in the posterior region of the mandible and the anterior part of the infrazygomatic crest region of the maxilla using intermaxillary elastics, we can expect a forward growth of the mandible in a growing child. Using this technique, the force vector will be in the oblique (forward-upward) direction. By installing mini-plates with a long connecting bar in the infrazygomatic crest region (with the orthodontic attachment head approximating the level of the occlusal plane), and mini-plates or -implants in the most posterior and superior regions of the mandible, such as the retromolar region, the force vector can be placed in the most horizontal direction possible. Evaluation of the hypothesis: In the literature, significant growth modification results were reported in skeletal Class III patients using intermaxillary elastics and bone-anchored devices fixed in both jaws, when compared with those in the nontreatment group. Therefore, in practice, intermaxillary elastics can produce enough traction to stimulate the bone to change and grow. Thus, we presume that inverting the direction of the force vector (i.e., posterior-anterior force) may have similar growth effects on the mandibles of growing children.