Elkordy, S. A., A. M. Abouelezz, M. M. S. Fayed, M. H. AboulFotouh, and Y. A. Mostafa, "Evaluation of the miniplate-anchored Forsus Fatigue Resistant Device in skeletal Class II growing subjects: A randomized controlled trial.", The Angle orthodontist, 2018. Abstract

OBJECTIVES:: To evaluate the use of direct miniplate anchorage in conjunction with the Forsus Fatigue Resistant Device (FFRD) in treatment of skeletal Class II malocclusion.

MATERIALS AND METHODS:: Forty-eight females with skeletal Class II were randomly allocated to the Forsus plus miniplates (FMP) group (16 patients, age 12.5 ± 0.9 years), Forsus alone (FFRD; 16 patients, age 12.1 ± 0.9 years), or the untreated control group (16 subjects, age 12.1 ± 0.9 years). After leveling and alignment, miniplates were inserted in the mandibular symphysis in the FMP group. The FFRD was inserted directly on the miniplates in the FMP group and onto the mandibular archwires in the FFRD group. The appliances were removed after reaching an edge-to-edge incisor relationship.

RESULTS:: Data from 46 subjects were analyzed. The effective mandibular length significantly increased in the FMP group only (4.05 ± 0.78). The mandibular incisors showed a significant proclination in the FFRD group (9.17 ± 2.42) and a nonsignificant retroclination in the FMP group (-1.49 ± 4.70). The failure rate of the miniplates was reported to be 13.3%.

CONCLUSIONS:: The use of miniplates with the FFRD was successful in increasing the effective mandibular length in Class II malocclusion subjects in the short term. The miniplate-anchored FFRD eliminated the unfavorable mandibular incisor proclination in contrast to the conventional FFRD.

Attia, K. H., S. A. Elkordy, M. ElKoussy, and A. M. Abouelezz, "Are self-ligating brackets' slots dimensions accurate?", International orthodontics, vol. 16, issue 4, pp. 613-622, 2018. Abstract

OBJECTIVE: The purpose of this study is to measure the dimensions of the slot's top and base of passive self-ligating brackets of three commercial and available systems and to compare the measured dimensions with the manufacturers' published dimensions.

METHODS: Digital microscope was used to measure the slot's top and base of 40 Central incisor brackets by three different manufacturers, Carriere SLX (Ortho Organizer, USA), Damon Q (Oramco USA) and Smart Clip (3M Unitek USA). The measurements were taken after the doors of all brackets were removed and compared with the manufacturers' claimed dimensions.

RESULTS: All brackets showed a significant increase in dimensions from both the slot's top and base compared to the manufacturers' published dimensions. For the base of the bracket's slot, Carriere SLX brackets showed the least difference while Damon Q brackets had the greatest. Moreover, for the top of the bracket's slot, the Smart clip brackets showed the greatest difference. The percentage of difference between the actual measurements and the manufacturers' prescriptions shows that for the slot's base, Carriere SLX brackets had the smallest percentage increase by .36%, followed by Smart clip by 6.7% and the Damon Q brackets by 8.1%. While for the slot's top Carriere SLX had the smallest percentage increase by .72%, followed by Damon Q by 12.3% increase and finally Smart Clip brackets by 12.8%.

CONCLUSIONS: The actual measurements of passive self-ligating brackets from 3 manufacturers were larger than the manufacturers' published dimension. This amount of increase may affect the amount torque expression.

El-Ashmawi, N. A., S. A. Elkordy, M. M. Salah Fayed, A. El-Beialy, and K. H. Attia, "Effectiveness of Gingivoperiosteoplasty on Alveolar Bone Reconstruction and Facial Growth in Patients With Cleft Lip and Palate: A Systematic Review and Meta-Analysis.", The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association, vol. 56, issue 4, pp. 438-453, 2019. Abstract

OBJECTIVE:: The aim of the systematic review is to evaluate the effects of gingivoperiosteoplasty (GPP) on alveolar bone quality and facial growth in patients with cleft lip and palate (CLP).

SEARCH METHODS:: Electronic and manual search was done up to October 2017.

ELIGIBILITY CRITERIA:: Clinical and observational studies that compared GPP to control; patients without GPP evaluated either before or after the age for secondary bone graft (SBG).

DATA COLLECTION AND ANALYSIS:: Studies selection was done by 2 authors independently. Risk ratio and mean difference with 95% confidence intervals (CIs) were calculated using random-effects models.

RESULTS:: Thirteen articles were included in the review. All studies were at high risk of bias. Poorer alveolar bone quality was found in the GPP group compared to the SBG group. The pooled data showed a statistically significant increase in the incidence of Bergland type III in the GPP group compared to SBG (risk ratio: 11.51, 95% CI: 3.39-35.15). As for facial growth, GPP group resulted in a more retruded maxillary position (as indicated by "Sella-Nasion-Subspinale" angle [SNA value]) compared to control group by -1.36 (CI: -4.21 to 1.49) and -1.66 (CI: -2.48 to -0.84) when evaluated at 5 and 10 years, respectively. The protocol for presurgical infant orthopedics used in conjunction with the GPP procedure might have affected the results of the alveolar bone and facial growth outcomes.

CONCLUSIONS:: Definitive conclusions about the effectiveness of GPP cannot be drawn. Very weak evidence indicated that GPP might not be an efficient method for alveolar bone reconstruction for patients with unilateral and bilateral CLP. Gingivoperiosteoplasty surgery could lead to maxillary growth inhibition in patients with CLP.

Elkordy, S. A., M. S. M. Fayed, A. M. Abouelezz, K. H. Attia, R. A. Ishaq, and Y. A. Mostafa, "Three-dimensional effects of the mini-implant-anchored Forsus Fatigue Resistant Device: A randomized controlled trial.", Angle Orthodontist, vol. 86, issue 2, pp. 292-305, 2015 Nov, 2016. Abstract

INTRODUCTION: The objective of this 2-arm parallel randomized controlled trial was to evaluate patient acceptance of the mini-implant anchored Forsus Fatigue Resistant Device (FFRD) (3M Unitek, Monrovia, Calif).

METHODS: The study included 32 skeletal Class II girls. The eligibility criteria included a deficient mandible, a horizontal or neutral growth pattern, an increased overjet, and a full set of erupted permanent teeth. After the leveling and alignment stage, FFRDs and mini-implants were inserted; they were removed after the teeth reached an edge-to-edge incisor relationship. The patients were afterward asked to fill out assessment questionnaires regarding their experience with the FFRD.

OUTCOMES: The primary outcome of this study was to assess patient acceptance of the appliance and satisfaction with the results. The secondary outcomes were interference with functional activities, noticeability by others, pain, swelling, gum problems caused by the appliance, and appliance breakage.

RANDOMIZATION: Computer random sequence generation was done using block sizes of 6 and 4. Allocation concealment was achieved with sequentially numbered opaque sealed envelopes.

BLINDING: Blinding of the clinicians and the patients to the intervention was impossible, but it was done for the outcome assessment and the statistician.

RESULTS: The 32 patients were randomly allocated in a 1:1 ratio into 2 groups: 16 patients (mean age, 13.25 ± 1.12 years) received the FFRD alone (FFRD group), and 16 patients (mean age, 13.07 ± 1.41 years) had mini-implants in conjunction with FFRDs (FMI group). No statistically significant differences were reported between the 2 groups regarding ease of appliance insertion, noticeability by others, pain, swelling, effects on eating and speech, and gum bleeding; 100% and 87.5% were satisfied with the results in the FFRD and FMI groups, respectively, with a ridit value of 0.57 (95% confidence interval, 0.43-0.71; P = 0.36). No serious harm was observed other than swelling of the cheeks, which occurred in 4 patients.

CONCLUSIONS: There were no significant differences between the patients' acceptance of the FFRD and the mini-implant anchored FFRD. They were highly satisfied with the results. Neither group reported significant functional limitations.

REGISTRATION: This trial was not registered.

PROTOCOL: The protocol was not published before trial commencement.

FUNDING: The study was self-funded by the authors.

Elkordy, S. A., A. AA, M. S. M. Fayed, A. F. MH, and A. AM, "Can the use of skeletal anchors in conjunction with fixed functional appliances promote skeletal changes? A systematic review and meta-analysis.", Eur J Orthod. , vol. 38, issue 5, pp. 532-45, 2015 Nov, 2016. Abstract

INTRODUCTION: The objective of this 2-arm parallel randomized controlled trial was to evaluate patient acceptance of the mini-implant anchored Forsus Fatigue Resistant Device (FFRD) (3M Unitek, Monrovia, Calif).

METHODS: The study included 32 skeletal Class II girls. The eligibility criteria included a deficient mandible, a horizontal or neutral growth pattern, an increased overjet, and a full set of erupted permanent teeth. After the leveling and alignment stage, FFRDs and mini-implants were inserted; they were removed after the teeth reached an edge-to-edge incisor relationship. The patients were afterward asked to fill out assessment questionnaires regarding their experience with the FFRD.

OUTCOMES: The primary outcome of this study was to assess patient acceptance of the appliance and satisfaction with the results. The secondary outcomes were interference with functional activities, noticeability by others, pain, swelling, gum problems caused by the appliance, and appliance breakage.

RANDOMIZATION: Computer random sequence generation was done using block sizes of 6 and 4. Allocation concealment was achieved with sequentially numbered opaque sealed envelopes.

BLINDING: Blinding of the clinicians and the patients to the intervention was impossible, but it was done for the outcome assessment and the statistician.

RESULTS: The 32 patients were randomly allocated in a 1:1 ratio into 2 groups: 16 patients (mean age, 13.25 ± 1.12 years) received the FFRD alone (FFRD group), and 16 patients (mean age, 13.07 ± 1.41 years) had mini-implants in conjunction with FFRDs (FMI group). No statistically significant differences were reported between the 2 groups regarding ease of appliance insertion, noticeability by others, pain, swelling, effects on eating and speech, and gum bleeding; 100% and 87.5% were satisfied with the results in the FFRD and FMI groups, respectively, with a ridit value of 0.57 (95% confidence interval, 0.43-0.71; P = 0.36). No serious harm was observed other than swelling of the cheeks, which occurred in 4 patients.

CONCLUSIONS: There were no significant differences between the patients' acceptance of the FFRD and the mini-implant anchored FFRD. They were highly satisfied with the results. Neither group reported significant functional limitations.

REGISTRATION: This trial was not registered.

PROTOCOL: The protocol was not published before trial commencement.

FUNDING: The study was self-funded by the authors.

Elkordy, S. A., M. S. M. Fayed, A. M. Abouelezz, and K. H. Attia, "Comparison of patient acceptance of the Forsus Fatigue Resistant Device with and without mini-implant anchorage: a randomized controlled trial.", American journal of orthodontics and dentofacial orthopedics : official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics, vol. 148, issue 5, pp. 755-64, 2015 Nov. Abstract

INTRODUCTION: The objective of this 2-arm parallel randomized controlled trial was to evaluate patient acceptance of the mini-implant anchored Forsus Fatigue Resistant Device (FFRD) (3M Unitek, Monrovia, Calif).

METHODS: The study included 32 skeletal Class II girls. The eligibility criteria included a deficient mandible, a horizontal or neutral growth pattern, an increased overjet, and a full set of erupted permanent teeth. After the leveling and alignment stage, FFRDs and mini-implants were inserted; they were removed after the teeth reached an edge-to-edge incisor relationship. The patients were afterward asked to fill out assessment questionnaires regarding their experience with the FFRD.

OUTCOMES: The primary outcome of this study was to assess patient acceptance of the appliance and satisfaction with the results. The secondary outcomes were interference with functional activities, noticeability by others, pain, swelling, gum problems caused by the appliance, and appliance breakage.

RANDOMIZATION: Computer random sequence generation was done using block sizes of 6 and 4. Allocation concealment was achieved with sequentially numbered opaque sealed envelopes.

BLINDING: Blinding of the clinicians and the patients to the intervention was impossible, but it was done for the outcome assessment and the statistician.

RESULTS: The 32 patients were randomly allocated in a 1:1 ratio into 2 groups: 16 patients (mean age, 13.25 ± 1.12 years) received the FFRD alone (FFRD group), and 16 patients (mean age, 13.07 ± 1.41 years) had mini-implants in conjunction with FFRDs (FMI group). No statistically significant differences were reported between the 2 groups regarding ease of appliance insertion, noticeability by others, pain, swelling, effects on eating and speech, and gum bleeding; 100% and 87.5% were satisfied with the results in the FFRD and FMI groups, respectively, with a ridit value of 0.57 (95% confidence interval, 0.43-0.71; P = 0.36). No serious harm was observed other than swelling of the cheeks, which occurred in 4 patients.

CONCLUSIONS: There were no significant differences between the patients' acceptance of the FFRD and the mini-implant anchored FFRD. They were highly satisfied with the results. Neither group reported significant functional limitations.

REGISTRATION: This trial was not registered.

PROTOCOL: The protocol was not published before trial commencement.

FUNDING: The study was self-funded by the authors.

Elkordy, S., A. Abouelezz, K. Attia, and M. S. Fayed, "Assessment of patient experience with Forsus Fatigue resistant Device: A Prospective Clinical Trial", Cairo Dental Journal, vol. 3, issue September 2014, pp. 1-9, 2014.