Abstract

When to Choose TADs in Class II Malocclusion with Mandibular Retrusion

by Luzi Cesare

One of the most common orthodontic problems is Class II malocclusion and mandibular retrognathism is accepted to be its most common variant. Growth stimulation of the mandible in the growing patient has been and is the most common treatment strategy for these cases. Functional appliances are well known and several studies report growth modification both at the condylar and at the glenoid fossa level, nevertheless the main problem related to removable appliances is time of wear and patient compliance, making this variable far more important than the choice of which functional appliance to use. The advantages of full-time wear and low requirements for patient compliance, which potentially affect treatment outcomes, are very clear today. Fixed functional appliances were introduced by Emil Herbst over 100 years ago and the Herbst appliance, thanks to Hans Pancherz, is still today an evidence-based state of the art class II corrector used all around the world. Indications and side-effects are well known and described in the literature, and although there is missing scientific evidence that skeletal response can be increased by controlling lower anterior flaring, clinical experience suggests that control of mandibular incisor proclination allows more space for the mandible to protrude. Several methods to reduce dental side-effects have been reported, but in many instances these methods do not yield satisfying improvements. For this reason, recently, to increase skeletal effects, temporary anchorage devices (TADs) have been used in conjunction with fixed functional appliances. The lecture will focus on the combination of mandibular advancement strategies using fixed functional appliances and TADs with an evidence-based discussion on indications, protocols, advantages and a cost-benefit analysis, supported by several clinical cases.

Learning Objectives

After this lecture, you will be able to understand the potential of TADs in modern orthodontics
After this lecture, you will be able to evaluate costs and benefits of TADs in class II treatment
After this lecture, you will be able to learn the combined protocols mandibular advancement with TADs