Functional and Orthopedic Treatments Supported By Skeletal Anchorage in Class II Malocclusions: A Comprehensive Literature Review

Introduction
As a result of the development of temporary anchorage devices, many different treatment alternatives have emerged in fixed and functional orthodontic treatments. It is frequently preferred by many clinicians due to its minimally invasive procedure and ease of application.

Aim
The aim of the comprehensive literature review was to evaluate the commonly used skeletal anchorage mechanics with the functional treatment of Class II malocclusion with mandibular retrognathia.

Material and methods
Functional appliances are commonly used in the treatment of skeletal Class II patients. However, unfavorable side effects, such as protrusion of lower incisors, retrusion of upper incisors limit the skeletal effect of these appliances. To overcome these disadvantages, skeletal anchorage devices are incorporated. More than 20 relevant articles were identified which investigated various types of skeletal anchorage approach. These systems were associated with a wide variety of success rates in the skeletal effect improvement and limiting of dentoalveolar compensation during treatment of skeletal Class II malocclusion.

Results
The corporation of skeletal anchorage devices with the functional appliance during treatment of skeletal Class II malocclusion was effective in minimizing protruded of mandibular incisors overcoming undesirable dentoalveolar effects, with considering the invasive surgical intervention and high cost of treatment.

Conclusions
Using intermaxillary elastics with bone-anchored devices fixed in both jaws or as alternative conjunction of Forsus appliance with the symphysis plate were significantly limited the growth of the maxilla and forward stimulating the development of the mandible. In addition to positively affection of the soft tissue by reducing facial profile convexity with considering the disadvantages represented by invasive surgical intervention and high cost of treatment.