Class II correction and FORSUS

Hi ESCO friends,

Very happy with the come back of ESCO as a straight forward – FREE expession site for real clinicians, without academical or dognatic restrictions or commercial interest in mind….Also about Class II correction and FORSUS:
I’ ve been using real HERBST tubes and plungers in combination with classic edgewise fixed appliances since 20 years.., thanks to the MALU system: “Mandibular Advancement Locking Unit” .
It is presented by a small company: SAGA co. from Norway. SAGA and the inventor of the system, Dr. Kumar Swadesch, is always present on AAO exhibition. It is an isometric system , without spring or helix:
THIS IS A REAL HERBST APPLIANCE !
I agree the learning curve is a bit difficult: you need strong bands, well adapted, etc.. Of course, there is some breakeage, especially of the lower arch wire, if the shape of the step bend was not smooth enough, but I can live with it. I almost never loose lower cuspid bracket’ s. WE must accept some technical failure, if we counteract muscles and nervous activity. This seems logic to me, especially for patiens with bruxomania extreme deep bite and a short and powerfull M. Masseter — sport activities – nervosity and stress…But witch alternative do we offer to this patient? elastics ? or a head gear ? or… Surgery !!
Of course, it is easier for the orthodontist to state from the beginning that there is no other way to correct the severe Class II of a given patient: you decide this – your patient accepts the treatment plan or not, and that’s up to him, – and you ‘ll sleep well… Of course, I present surgery as an option for cases that need an mandibular – pogonion – advancement for esthetical reasons.
It is difficult to “grow” the mandible on a long term basis with orthopedics, only the Herbst appliance can do it…a bit.( Aelbers and Dermaut – AJO 1996 ) The result is always individual and unpredictable, but for many cases there is some skeletal change. For the Herbst appliance this skelettal change is about 22°. But it corrects nicely most Class II malocclusions. And not every patient wants or needs a radical profile change …
With the MALU – HERBST system, most cases work very well … it is relatively cheap , no lab work, (only cut the tube and plunger to the right lenght with a diamond disk ), it is well tolerated by the patient.
Unilateral application is possible .
This system is not well known, due to the lack of interest of the mean companies … There are only few publications: J. C. O . 1996 

.	Modified Edgewise herbst Appliance RAFFAELE SCHIAVONI, MD, DDS, MS, CARLO BONAPACE, MD, DDS, VITTORIO GRENGA, MD, DDS VOLUME 30 : NUMBER 12 : PAGE 681 : Dec : 1996

This is my routine Class II correction procedure, I have always about 10 cases in treatment – respecting the Proffitt – and O ‘Brien studies, that proved efficacy and efficiency of a One stage treatment in the permanent dentition..
Hereby some pictures of the system — other pictures of many treated cases are available on request ..).
Good luck !
Marc Van Rossen