Miniplate-anchored Forsus fatigue-resistant device with a fail-safe attachment

The Forsus fatigue resistance device (FRD) is a widely used appliance for correcting skeletal Class II malocclusion in late adolescence. However, it is associated with dentoalveolar side effects such as mandibular incisor protrusion, limiting its effectiveness. In this study, we introduced the bimaxillary anchored Forsus-FRD appliance system with a superior anchorage mechanism. The appliance design incorporates a fail-safe attachment system, offering the following advantages: fail-safe design, customizable dimensions, simple fabrication, cost-effectiveness, versatility in angulation, and a quick-release system. The bimaxillary anchored Forsus-FRD demonstrated skeletal Class II correction with greater skeletal and less dentoalveolar effects. The technique resulted in increased mandibular length, anterior mandibular positioning, and minimal posterior displacement of the maxillary region. Dental changes included retroclination of maxillary incisors and limited proclination of mandibular incisors. The molar relationship was corrected to Class I, primarily because of skeletal changes. Soft tissue analysis showed improved facial esthetics, with notable improvement in the position of the lower lip. The bimaxillary miniplate–anchored Forsus-FRD offers an effective treatment modality for patients in late adolescence, either because of noncompliance with removable functional appliances or those who consult the orthodontist at an older age. This technique not only minimizes the undesirable effects but also circumvents the need for orthognathic surgery by using residual growth.