Forsus

forays

1. Forsus ™ FRD Sinan Al- Hadeed Supervised by: Dr. Ahmad Altarawneh Dr. Jumana Tbeishat Dr. Bashar Almomani Dr. Anwar Alrahamneh

2. What is “ Forsus ™” appliance? Developed by Bill Vogt in 2001. Considered one of the Flexible Fixed Functional Appliances. All of which have a “flexible” component such as a spring and can be used with a fixed pre-adjusted Edgewise appliance. The second most popular functional appliance used by orthodontists in the UK, USA, and Australia.

3. Components of Forsus ™ FRD Spring Modules: EZ2 Module. L-pin Spring Module. Push Rods. Split Crimps. Measurement Gauge.

4. Spring Modules: EZ2 Module.

5. L-pin Spring Module

6. Push Rods. The push rods come in six different lengths and are oriented to the patient’s right and left. 22, 25, 29, 32, 35, and 38. The proper size is selected using the Measurement Gauge

7. Split Crimps.

8. Instruments used with Forsus ™ FRD Weingart Utility Pliers.

9. When to use Forsus ™ FRD? Class II cases where the patient did not show a good cooperation in using class II elastics. Upright or retroclined lower labial segment. Proclined upper labial segment. It is necessary to plan the use of Forsus in the original treatment plan and not as a “bail-out” class II correction.

10. Setting up for Forsus Use upper molar bands with occlusal headgear tubes. TPA might be useful in avoiding expanding the upper first molars or try to band the upper second molars to decrease the tendency of buccal flaring of the molars. Avoid using the device in a crowded upper labial segment instead use sectional arch wire extending from the canine to the molar region.

11. Setting up for Forsus It is important to enforce the lower arch anchorage by: Including the lower second molars. Make sure that the lower arch spaces are closed. Use steel ligation or tie-backs to secure the lower arch and avoid reopening of spaces. Ligation of the lower Canines or First premolars are important even when using SLB. Use lower labial brackets with increased buccal root torque (- ve ) torque Start using Forsus only with riged S.S arch wire. A minimum of 0.017 × 0.025 S.S archwire is recommended for 0.018 slot in the maxillary and mandibular arches. 0.019 × 0.025 S.S archwire is recommended for 0.022 slot.

12. Assess mandibular incisor position. Factor in existing proclination and any additional proclining that will occur when eliminating crowding and the Curve of Spee . Consider whether extractions or interproximal reduction may be indicated to upright mandibular incisors where proclination is excessive . You should make sure that the upper and lower arches are well coordinated and you don’t end up in buccal cross-bite after correction. “Expand the upper arch.”

13. Canine or First premolar? Actually there are three places where you can place the push rod:

14. First premolar. Placing the push rod distal to the first premolar is a more recent recommendation for placement. The benefits include improved patient comfort, better aesthetics and reduced interference. Canine. The traditional location to place the push rod is distal to the canine. Placement behind the canine will work in most cases, especially when the premolar is not an option, for example: When placement at first premolars is over-active with a 22 mm push rod. When placement is more vertical than needed. Severe Class II malocclusions where a large portion of the discrepancy is from a retruded mandible. Omega Loop. Using an Omega Loop allows the angulation to be varied. It will also keep the push rod from contacting the bracket. Omega Loop. Using an Omega Loop allows the angulation to be varied. It will also keep the push rod from contacting the bracket.

15. Push Rod Selection Use the Measurement Guide to determine correct push rod length, depending on the selected push rod location (distal to canine, first premolar, Omega loop). Measure each side from the distal end of maxillary molar tube to the distal side of the chosen mandibular stop, having the patient bite in centric occlusion without advancing the mandible. When in doubt, use the shorter length push rod. Select the Right and Left configuration push rods from the available sizes.

16. Review visits The patient should be reviewed every 6-8 weeks. Check for: Lower labial segment position; over-jet and spaces. Molar and canine relationships. Upper molar position; intrusion and buccal flaring. Lower canine or premolar bracket and ligation. Breakage of the appliance or patient’s complaints.

17. Split Crimps Split crimps are used to reactivate the spring module as treatment progresses. The recommendation is to add one split crimp (1.5 mm of activation) to the push rod, and if another crimp is needed, move to the next size push rod . Over activated appliance will show a closed compressed spring and might extrude the rod from the coil assembly. This will cause discomfort, breakage of the lower brackets, and unwanted side effects.

18. How to deal with emergencies The patient should be instructed on how to sustain a satisfactory level of oral hygiene. Emergencies include broken lower brackets, molar band/tube loosening, broken appliance, trauma or irritation to the oral tissues, and disassembled appliance system.

19. In case of disassembly, the patient is instructed to compress the spring and try to insert the rod within the assembly. If it was found to be difficult the patient will try to use an elastic or a dental floss to secure the segments with the main archwires . And schedule an emergency visit as soon as possible.

20. Thank you