3. 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.
4.
5. Components of Forsus™ FRD
• Spring Modules:
– EZ2 Module.
– L-pin Spring Module.
• Push Rods.
• Split Crimps.
• Measurement Gauge.
8. • 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
11. 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.
12. 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.
13. 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.
14. • 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.”
15.
16. Canine or First premolar?
• Actually there are three places where you can
place the push rod:
17. 1. 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.
2. 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:
1. When placement at first premolars is over-active with a 22 mm
push rod.
2. When placement is more vertical than needed.
3. Severe Class II malocclusions where a large portion of the
discrepancy is from a retruded mandible.
3. 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.
18.
19. 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.
20. 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.
21. • 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.
22. 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.
23. • 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.
