{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T15:05:05Z","timestamp":1780067105829,"version":"3.54.0"},"reference-count":50,"publisher":"The Angle Orthodontist (EH Angle Education & Research Foundation)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To evaluate and compare dentoalveolar changes after orthopedic treatment of growing skeletal Class II patients using either pushing or pulling force mechanics anchored to bimaxillary miniplates in comparison with deferred treatment control subjects.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>A total of 39 patients (24 male, 15 female; mean age 11.59 \u00b1 0.56 years) was equally and randomly allocated to one of three study groups: pushing group (A), pulling group (B), and control group (C). Dental changes were assessed using pretreatment (T1) and posttreatment (T2) cone-beam computed tomography scans.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>One patient dropped out; therefore, 13, 12, and 13 patients were analyzed in groups A, B, and C, respectively. In groups A and B, overjet decreased by 7.00 \u00b1 1.35 mm and 8.17 \u00b1 1.4 mm, respectively. No significant change was observed in axial inclination of the mandibular incisors in either of the intervention groups between T1 and T2. Axial inclination of the maxillary incisors decreased significantly in Group B by 3.75 \u00b1 1.71\u00b0. The sagittal position of the mandibular first molar changed significantly in Group A (4.15 \u00b1 1.28 mm) and Group B (4.00 \u00b1 1.41 mm). Maxillomandibular basal arch width differences were greater than \u22120.39 \u00b1 1.87 mm in all study groups. No significant transverse arch measurement changes were observed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The use of either pushing or pulling force mechanics using bimaxillary skeletal anchorage was effective in improving Class II dental relationships without dentoalveolar side effects. Pretreatment transverse discrepancy should be assessed to incorporate maxillary expansion into the treatment protocol for patients diagnosed with maxillary arch constriction.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2319\/111324-935.1","type":"journal-article","created":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T00:51:50Z","timestamp":1770771110000},"page":"28-40","source":"Crossref","is-referenced-by-count":0,"title":["Comparison between two bone anchored force systems for correction of skeletal Class II malocclusion in growing patients: a randomized controlled clinical trial, part 2: short-term dentoalveolar changes"],"prefix":"10.2319","volume":"96","author":[{"given":"Yasmine M.","family":"Mahmoud","sequence":"first","affiliation":[{"name":"PhD Resident, Department of Orthodontics, Faculty of Dentistry, Alexandria University, Alexandria, Egypt."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eiman S.","family":"Marzouk","sequence":"additional","affiliation":[{"name":"Professor, Department of Orthodontics, Faculty of Dentistry, Alexandria University, Alexandria, Egypt."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adham A.","family":"El Ashwah","sequence":"additional","affiliation":[{"name":"Professor, Department of Oral Surgery, Faculty of Dentistry, Alexandria University, Alexandria, Egypt."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hanan A.","family":"Ismail","sequence":"additional","affiliation":[{"name":"Professor, Department of Orthodontics, Faculty of Dentistry, Alexandria University; and Professor, Department of Orthodontics, Faculty of Dentistry, Pharos University, Alexandria, Egypt."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sherief H.","family":"Abdel-Haffiez","sequence":"additional","affiliation":[{"name":"Assistant Professor, Department of Orthodontics, Faculty of Dentistry, Alexandria University, Alexandria, Egypt."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1164","reference":[{"key":"i1945-7103-96-1-28-b01","series-title":"Semin Orthod","first-page":"11","article-title":"Class II malocclusions: diagnostic and clinical considerations with and without treatment","volume":"12","author":"Bishara","year":"2006","unstructured":"Bishara SE. Class II malocclusions: diagnostic and clinical considerations with and without treatment. Semin Orthod. 2006;12:11\u201324."},{"issue":"6","key":"i1945-7103-96-1-28-b02","series-title":"Sys Rev Pharm","first-page":"511","article-title":"A systematic review of oral myofunctional therapy, methods and development of class ii skeletal malocclusion treatment in children","volume":"11","author":"Harun","year":"2020","unstructured":"Harun A,\nNurul M,\nYunita FR. A systematic review of oral myofunctional therapy, methods and development of class ii skeletal malocclusion treatment in children. Sys Rev Pharm. 2020;11(6):511\u2013521."},{"issue":"3","key":"i1945-7103-96-1-28-b03","series-title":"J Indian Orthod Soc","first-page":"180","article-title":"S. Evaluation of dentoalveolar, skeletal and soft-tissue changes with FFA including the multibracket system: a meta-analysis","volume":"54","author":"Shruti","year":"2020","unstructured":"Shruti P,\nMukesh K,\nHemant S,\nManish G,\nSonika Ashish K, S. Evaluation of dentoalveolar, skeletal and soft-tissue changes with FFA including the multibracket system: a meta-analysis. J Indian Orthod Soc. 2020;54(3):180\u2013194."},{"key":"i1945-7103-96-1-28-b04","series-title":"Am J Orthod Dentofacial Orthop","first-page":"612","article-title":"Fixed functional appliances with multibracket appliances have no skeletal effect on the mandible: a systematic review and meta-analysis","volume":"149","author":"Ishaq","year":"2016","unstructured":"Ishaq RAR,\nAlHammadi MS,\nFayed MMS,\nEl-Ezz AA,\nMostafa Y. Fixed functional appliances with multibracket appliances have no skeletal effect on the mandible: a systematic review and meta-analysis. Am J Orthod Dentofacial Orthop. 2016;149: 612\u2013624."},{"key":"i1945-7103-96-1-28-b05","series-title":"Eur J Orthod","first-page":"113","article-title":"Treatment effects of fixed functional appliances in patients with Class II malocclusion: a systematic review and meta-analysis","volume":"38","author":"Zymperdikas","year":"2016","unstructured":"Zymperdikas VF,\nKoretsi V,\nPapageorgiou SN,\nPapadopoulos MA. Treatment effects of fixed functional appliances in patients with Class II malocclusion: a systematic review and meta-analysis. Eur J Orthod. 2016; 38:113\u2013126."},{"key":"i1945-7103-96-1-28-b06","series-title":"Angle Orthod","first-page":"391","article-title":"Evaluation of the miniplate-anchored Forsus Fatigue Resistant Device in skeletal Class II growing subjects: a randomized controlled trial","volume":"89","author":"Elkordy","year":"2019","unstructured":"Elkordy S,\nAbouelezz A,\nFayed M,\nAboulfotouh M,\nMostafa Y. Evaluation of the miniplate-anchored Forsus Fatigue Resistant Device in skeletal Class II growing subjects: a randomized controlled trial. Angle Orthod. 2019;89:391\u2013403."},{"issue":"6","key":"i1945-7103-96-1-28-b07","series-title":"Angle Orthod","first-page":"1026","article-title":"Effects of miniplate anchored and conventional Forsus Fatigue Resistant Devices in the treatment of Class II malocclusion","volume":"86","author":"Turkkahraman","year":"2016","unstructured":"Turkkahraman H,\nEliacik SK,\nFindik Y. Effects of miniplate anchored and conventional Forsus Fatigue Resistant Devices in the treatment of Class II malocclusion. Angle Orthod. 2016;86(6):1026\u20131032."},{"key":"i1945-7103-96-1-28-b08","series-title":"Angle Orthod","first-page":"413","article-title":"Evaluation of the effects of skeletal anchoraged Forsus FRD using miniplates inserted on mandibular symphysis: a new approach for the treatment of Class II malocclusion","volume":"85","author":"Unal","year":"2015","unstructured":"Unal T,\nCelikoglu M,\nCandirli C. Evaluation of the effects of skeletal anchoraged Forsus FRD using miniplates inserted on mandibular symphysis: a new approach for the treatment of Class II malocclusion. Angle Orthod. 2015; 85:413\u2013419."},{"key":"i1945-7103-96-1-28-b09","series-title":"Eur J Dent","first-page":"276","article-title":"Treatment of a skeletal Class II malocclusion using \ufb01xed functional appliance with miniplate anchorage","volume":"8","author":"Celikoglu","year":"2014","unstructured":"Celikoglu M,\nUnal T,\nBayram M,\nCandirli C. Treatment of a skeletal Class II malocclusion using \ufb01xed functional appliance with miniplate anchorage. Eur J Dent. 2014; 8:276\u2013280."},{"key":"i1945-7103-96-1-28-b10","series-title":"J OrofacOrthop","first-page":"42","article-title":"Management of skeletal Class II malocclusion using bimaxillary skeletal anchorage supported fixed functional appliances: a novel technique","volume":"82","author":"Kochar","year":"2021","unstructured":"Kochar GD,\nLondhe SM,\nShivpuri A,\nChopra SS,\nRajat M,\nMunish V. Management of skeletal Class II malocclusion using bimaxillary skeletal anchorage supported fixed functional appliances: a novel technique. 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Am J Orthod Dentofacial Orthop. 2018;153:239\u2013247."},{"key":"i1945-7103-96-1-28-b13","series-title":"BMC Oral Health","first-page":"339","article-title":"Skeletal and dentoalveolar effects of Class II malocclusion treatment using bi-maxillary skeletal anchorage: a systematic review","volume":"22","author":"Alhammadi","year":"2022","unstructured":"Alhammadi MS,\nQasem AA,\nYamani AM, et al. Skeletal and dentoalveolar effects of Class II malocclusion treatment using bi-maxillary skeletal anchorage: a systematic review. BMC Oral Health. 2022;22:339."},{"issue":"5","key":"i1945-7103-96-1-28-b14","series-title":"J Orofacial Orthop","first-page":"373","article-title":"Arch changes after Class II, division 1 treatment with jumping-the-bite appliances","volume":"69","author":"Stec-Slonicz","year":"2008","unstructured":"Stec-Slonicz M,\nWeindel S,\nPaurevic S,\nLisson A. Arch changes after Class II, division 1 treatment with jumping-the-bite appliances. J Orofacial Orthop. 2008;69(5):373\u2013382."},{"issue":"1","key":"i1945-7103-96-1-28-b15","series-title":"Int J Surg","first-page":"28","article-title":"CONSORT 2010 explanation and elaboration: updated guidelines for reporting parallel group randomised trials","volume":"10","author":"Moher","year":"2012","unstructured":"Moher D,\nHopewell S,\nSchulz KF, et al. CONSORT 2010 explanation and elaboration: updated guidelines for reporting parallel group randomised trials. Int J Surg. 2012;10(1):28\u201355."},{"issue":"6","key":"i1945-7103-96-1-28-b16","series-title":"Angle Orthod","first-page":"824","article-title":"Treatment outcomes of Class II malocclusion cases treated with miniscrew-anchored Forsus Fatigue Resistant Device: a randomized controlled trial","volume":"87","author":"Eissa","year":"2017","unstructured":"Eissa O,\nEl-Shennawy M,\nGaballah S,\nEl-Meehy G,\nEl Bialy T. 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Evaluation of the splint-supported Forsus Fatigue Resistant Device in skeletal Class II growing subjects. Angle Orthod. 2021;91:9\u201321."},{"issue":"2","key":"i1945-7103-96-1-28-b22","series-title":"Am J Orthod Dentofacial Orthop","first-page":"208","article-title":"Development of a maxillomandibular arch form based on the center of resistance of teeth using cone-beam computed tomography","volume":"161","author":"Moon","year":"2022","unstructured":"Moon HW,\nNam W,\nAhn HW,\nOh SH,\nKook YA,\nKim SH. Development of a maxillomandibular arch form based on the center of resistance of teeth using cone-beam computed tomography. 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Angle Orthod. 2005;75(6):941\u2013947."},{"issue":"2","key":"i1945-7103-96-1-28-b25","series-title":"Am J Orthod Dentofacial Orthop","first-page":"202","article-title":"Analysis of dental and basal bone arch form correlations in skeletal Class II malocclusion","volume":"159","author":"Fu","year":"2021","unstructured":"Fu K,\nFang S,\nFan X, et al. Analysis of dental and basal bone arch form correlations in skeletal Class II malocclusion. Am J Orthod Dentofacial Orthop. 2021;159(2):202\u2013209."},{"key":"i1945-7103-96-1-28-b01","series-title":"Semin Orthod","first-page":"11","article-title":"Class II malocclusions: diagnostic and clinical considerations with and without treatment","volume":"12","author":"Bishara","year":"2006","unstructured":"Bishara SE. Class II malocclusions: diagnostic and clinical considerations with and without treatment. Semin Orthod. 2006;12:11\u201324."},{"issue":"6","key":"i1945-7103-96-1-28-b02","series-title":"Sys Rev Pharm","first-page":"511","article-title":"A systematic review of oral myofunctional therapy, methods and development of class ii skeletal malocclusion treatment in children","volume":"11","author":"Harun","year":"2020","unstructured":"Harun A,\nNurul M,\nYunita FR. A systematic review of oral myofunctional therapy, methods and development of class ii skeletal malocclusion treatment in children. Sys Rev Pharm. 2020;11(6):511\u2013521."},{"issue":"3","key":"i1945-7103-96-1-28-b03","series-title":"J Indian Orthod Soc","first-page":"180","article-title":"S. Evaluation of dentoalveolar, skeletal and soft-tissue changes with FFA including the multibracket system: a meta-analysis","volume":"54","author":"Shruti","year":"2020","unstructured":"Shruti P,\nMukesh K,\nHemant S,\nManish G,\nSonika Ashish K, S. Evaluation of dentoalveolar, skeletal and soft-tissue changes with FFA including the multibracket system: a meta-analysis. J Indian Orthod Soc. 2020;54(3):180\u2013194."},{"key":"i1945-7103-96-1-28-b04","series-title":"Am J Orthod Dentofacial Orthop","first-page":"612","article-title":"Fixed functional appliances with multibracket appliances have no skeletal effect on the mandible: a systematic review and meta-analysis","volume":"149","author":"Ishaq","year":"2016","unstructured":"Ishaq RAR,\nAlHammadi MS,\nFayed MMS,\nEl-Ezz AA,\nMostafa Y. Fixed functional appliances with multibracket appliances have no skeletal effect on the mandible: a systematic review and meta-analysis. 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Evaluation of the miniplate-anchored Forsus Fatigue Resistant Device in skeletal Class II growing subjects: a randomized controlled trial. Angle Orthod. 2019;89:391\u2013403."},{"issue":"6","key":"i1945-7103-96-1-28-b07","series-title":"Angle Orthod","first-page":"1026","article-title":"Effects of miniplate anchored and conventional Forsus Fatigue Resistant Devices in the treatment of Class II malocclusion","volume":"86","author":"Turkkahraman","year":"2016","unstructured":"Turkkahraman H,\nEliacik SK,\nFindik Y. Effects of miniplate anchored and conventional Forsus Fatigue Resistant Devices in the treatment of Class II malocclusion. Angle Orthod. 2016;86(6):1026\u20131032."},{"key":"i1945-7103-96-1-28-b08","series-title":"Angle Orthod","first-page":"413","article-title":"Evaluation of the effects of skeletal anchoraged Forsus FRD using miniplates inserted on mandibular symphysis: a new approach for the treatment of Class II malocclusion","volume":"85","author":"Unal","year":"2015","unstructured":"Unal T,\nCelikoglu M,\nCandirli C. Evaluation of the effects of skeletal anchoraged Forsus FRD using miniplates inserted on mandibular symphysis: a new approach for the treatment of Class II malocclusion. Angle Orthod. 2015; 85:413\u2013419."},{"key":"i1945-7103-96-1-28-b09","series-title":"Eur J Dent","first-page":"276","article-title":"Treatment of a skeletal Class II malocclusion using \ufb01xed functional appliance with miniplate anchorage","volume":"8","author":"Celikoglu","year":"2014","unstructured":"Celikoglu M,\nUnal T,\nBayram M,\nCandirli C. Treatment of a skeletal Class II malocclusion using \ufb01xed functional appliance with miniplate anchorage. Eur J Dent. 2014; 8:276\u2013280."},{"key":"i1945-7103-96-1-28-b10","series-title":"J OrofacOrthop","first-page":"42","article-title":"Management of skeletal Class II malocclusion using bimaxillary skeletal anchorage supported fixed functional appliances: a novel technique","volume":"82","author":"Kochar","year":"2021","unstructured":"Kochar GD,\nLondhe SM,\nShivpuri A,\nChopra SS,\nRajat M,\nMunish V. Management of skeletal Class II malocclusion using bimaxillary skeletal anchorage supported fixed functional appliances: a novel technique. 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Am J Orthod Dentofacial Orthop. 2018;153:239\u2013247."},{"key":"i1945-7103-96-1-28-b13","series-title":"BMC Oral Health","first-page":"339","article-title":"Skeletal and dentoalveolar effects of Class II malocclusion treatment using bi-maxillary skeletal anchorage: a systematic review","volume":"22","author":"Alhammadi","year":"2022","unstructured":"Alhammadi MS,\nQasem AA,\nYamani AM, et al. Skeletal and dentoalveolar effects of Class II malocclusion treatment using bi-maxillary skeletal anchorage: a systematic review. BMC Oral Health. 2022;22:339."},{"issue":"5","key":"i1945-7103-96-1-28-b14","series-title":"J Orofacial Orthop","first-page":"373","article-title":"Arch changes after Class II, division 1 treatment with jumping-the-bite appliances","volume":"69","author":"Stec-Slonicz","year":"2008","unstructured":"Stec-Slonicz M,\nWeindel S,\nPaurevic S,\nLisson A. Arch changes after Class II, division 1 treatment with jumping-the-bite appliances. 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Treatment outcomes of Class II malocclusion cases treated with miniscrew-anchored Forsus Fatigue Resistant Device: a randomized controlled trial. Angle Orthod. 2017;87(6):824\u2013833."},{"key":"i1945-7103-96-1-28-b17","author":"Universit\u00e4t D\u00fcsseldorf. G*Power.","year":"2019","unstructured":"Universit\u00e4t D\u00fcsseldorf. G*Power. 2019. Retrieved from http:\/\/www.gpower.hhu.de."},{"key":"i1945-7103-96-1-28-b18","series-title":"Fundamentals of Biostatistics","author":"Rosner","year":"2006","unstructured":"Rosner BA. Fundamentals of Biostatistics. Belmont, CA: Thomson-Brooks\/Cole; 2006."},{"issue":"9306","key":"i1945-7103-96-1-28-b19","series-title":"Lancet","first-page":"614","article-title":"Allocation concealment in randomised trials: defending against deciphering","volume":"359","author":"Schulz","year":"2002","unstructured":"Schulz KF,\nGrimes DA. Allocation concealment in randomised trials: defending against deciphering. Lancet. 2002;359(9306):614\u2013618."},{"issue":"3","key":"i1945-7103-96-1-28-b20","series-title":"Korean J Orthod","first-page":"167","article-title":"Maxillomandibular arch width differences at estimated centers of resistance: comparison between normal occlusion and skeletal Class III malocclusion","volume":"47","author":"Koo","year":"2017","unstructured":"Koo YJ,\nChoi SH,\nKeum BT, et al. Maxillomandibular arch width differences at estimated centers of resistance: comparison between normal occlusion and skeletal Class III malocclusion. Korean J Orthod. 2017;47(3):167\u2013175."},{"key":"i1945-7103-96-1-28-b21","series-title":"Angle Orthod","first-page":"9","article-title":"Evaluation of the splint-supported Forsus Fatigue Resistant Device in skeletal Class II growing subjects","volume":"91","author":"Elkordy","year":"2021","unstructured":"Elkordy SH,\nAbdeldayem R,\nFayed MS,\nNegm I,\nEl Ghoul D,\nAbouelezz AM. Evaluation of the splint-supported Forsus Fatigue Resistant Device in skeletal Class II growing subjects. Angle Orthod. 2021;91:9\u201321."},{"issue":"2","key":"i1945-7103-96-1-28-b22","series-title":"Am J Orthod Dentofacial Orthop","first-page":"208","article-title":"Development of a maxillomandibular arch form based on the center of resistance of teeth using cone-beam computed tomography","volume":"161","author":"Moon","year":"2022","unstructured":"Moon HW,\nNam W,\nAhn HW,\nOh SH,\nKook YA,\nKim SH. Development of a maxillomandibular arch form based on the center of resistance of teeth using cone-beam computed tomography. Am J Orthod Dentofacial Orthop. 2022;161(2):208\u2013219."},{"key":"i1945-7103-96-1-28-b23","series-title":"Heliyon","first-page":"e28267","article-title":"Comparison between basal arch width in normal occlusions and Class II malocclusions by using cone-beam computed tomography","volume":"10","author":"Zhang","year":"2024","unstructured":"Zhang H,\nGuo D,\nMa Y, et al. Comparison between basal arch width in normal occlusions and Class II malocclusions by using cone-beam computed tomography. Heliyon. 2024;10:e28267."},{"issue":"6","key":"i1945-7103-96-1-28-b24","series-title":"Angle Orthod","first-page":"941","article-title":"Dental and alveolar arch widths in normal occlusion, Class II division 1 and Class II division 2","volume":"75","author":"Uysal","year":"2005","unstructured":"Uysal T,\nMemili B,\nUsumez S,\nSari Z. Dental and alveolar arch widths in normal occlusion, Class II division 1 and Class II division 2. 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