Pacific Coast Society of Orthodontists Bulletin Summer 2020 - 38

PCSO Program Talk

in the cases for which they are indicated. They
include headgear with or without an anterior
bite plate (with or without fixed 2 × 4 appliances), functional appliances, and fixed "Class II correctors." Some programs report the use of less
headgear and more fixed functional appliances
for Phase I Class II treatments in their clinic over
the past decade while other programs have not
noticed any changes in the treatment protocols
for the Phase I Class II treatment modalities in
their clinic over the past decade. The University
of the Pacific reported that they have recently
started using Invisalign First (Align Technology,
San Jose, Calif). Invisalign First is Align Technology's new product that is designed to treat Phase
I cases.
New Treatment Modalities for Phase I Class II
Treatment in Growing Patients
A couple of new appliances and treatment modalities have gained popularity during the past
decade for Class II correction. The most recent one
is the "mandibular advancement" (MA) feature
of Invisalign (Align Technology, San Jose, Calif). It
adds "wings" in the maxillary and mandibular regions of the aligners. The design is similar to the
blocks of the twin-block appliance or the arms of
the mandibular anterior repositioning appliance
(MARA). While two PCSO postgraduate orthodontic programs have not started using the Invisalign
MA feature yet, three of them have used it for
treating Class II malocclusion in growing patients.
Another Class II treatment modality that has
been popularized in the past decade is the Carriere® Motion 3DTM appliance (CMA; Henry Schein
Orthodontics, Carlsbad, Calif).8 CMA is composed
of two rigid bars bonded to the maxillary canines
(or first premolars) and first molars bilaterally.8
Patients wear Class II elastics from the hooks of
the CMA to the brackets/buttons on the mandibular first molars (or second molars). The mandibular anchorage devices for the CMA include
a removable vacuum-formed clear retainer,9 a
lower lingual holding arch, temporary anchorage
devices, and fixed appliances.10 When asked if

38	

they use any new products or treatment modalities that have been recently introduced and
popularized for treating Class II malocclusion in
growing and nongrowing patients, most of the
programs reported that they use CMA.
Noncompliance Treatment Modalities for Class II
Correction
Patient noncompliance can be an issue in orthodontics, especially when patients are required to
wear Class II elastics as part of their orthodontic
treatment. There are multiple methods to deal
with noncompliance, including motivational interviewing, positive and negative reinforcement,11
visual aids, acceptance of compromised treatment results, and the use of noncompliance fixed
functional appliances or fixed Class II correctors.
The noncompliance fixed functional appliances
include the Forsus Fatigue Resistant Device (3M
Unitek), PowerScope 2 Class II Corrector (American Orthodontics, Sheboygan, Wis), CS4TM Class
II Corrector (DynaFlex, St Ann, MO), Twin Force®
Bite Corrector (TFBC; Henry Schein Orthodontics),
among others. When patients fail to comply with
Class II elastic wear, the PCSO postgraduate orthodontic programs that responded to our survey use
fixed Class II correctors such as Forsus, PowerScope 2, and CS4 Class II Corrector as well as TFBC.
The University of Washington reported that they
use MARA, Herbst, and CMA in addition to the
fixed Class II correctors while AT Still University reported that they use Herbst and CMA in addition
to the fixed Class II correctors for these cases.
Orthognathic Surgery for Class II Correction
When nongrowing patients present with skeletal
Class II malocclusion for which orthognathic
surgery is indicated, programs reported that
approximately 1% to 5% of the population has the
orthognathic surgery. Similarly, Proffit et al12 noted that about 5% of Class II patients in their clinic
at the University of North Carolina were potential
candidates for orthognathic surgery.
Overall, there is commonality across the PCSO
postgraduate orthodontic programs regarding

PCSO Bulletin    Summer 2020



Pacific Coast Society of Orthodontists Bulletin Summer 2020

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