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Objective: To compare the effectiveness of the clear aligners with the traditional fixed appliances in the treatment of premolars extraction complex cases using the American Board of Orthodontics Objective Grading System (ABO-OGS)., Material and Methods: A single-centre, 2-parallel groups RCT with two arms. Forty severe crowding patients (14 males, 26 females; mean age: 21.40±2.42) who required four first premolars extraction were included and randomly allocated into two treatment groups: clear aligners therapy group (CAT), and fixed appliances therapy group (FAT). Cases complexities were measured on pre-treatment records using the Discrepancy index (DI). Post-treatment records were evaluated using the American Board of Orthodontics Objective Grading System (ABO-OGS). Two sample t-tests and Fisher's Exact tests were used to test for significant differences between the two groups. The statistical significance was set at P < 0.006 using Bonferroni's correction., Results: For the DI, the mean scores were 32.25 (± 4.33) in the CAT group and 33 (± 7.92) in the FAT group. In the CAT group, the total OGS score ranged between 6-33 points with an average of 17.50(± 7.41), whereas the total score in the FAT group went between 4-30 points with an average of 12.89 (± 6.31) with no significant differences between the two groups (P=0.05). When comparison of the successful cases between the two groups was made, 11 cases received passing scores, and 9 cases received failing scores in the CAT group. Whereas in the FAT group, 17 cases received passing scores, and 3 received a failing score. No statistically significant differences were found in the passing rates between of the CAT and FAT groups (P = 0.421)., Conclusions: According to the ABO-OGS total scores, there was no significant difference between the clear aligners and fixed appliances in the treatment of class I severe crowding cases with first premolars extraction in young adults. There were no differences between the two techniques in the OGS components scores except for the occlusal contacts, which were significantly better with the fixed appliances. When comparing the number of successful and failed cases between the two groups, no significant differences were noted, with the fixed appliances having a 30% higher success rate than the clear aligners, which must be considered clinically when choosing between these two techniques in the complex orthodontic cases treatment., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Objective: This systematic review and meta-analysis aimed to critically appraise the available evidence of the effectiveness of early intervention of functional unilateral posterior crossbites (FPXB) between the ages of 6 and 12 years., Materials and Methods: Electronic search in four databases (PubMed, Scopus, Embase, and Google Scholar) for randomized controlled trials (RCTs) and controlled clinical trials (CCTs) was performed between 1 st January 1990 and 31 st October 2021. Methodological index for non-randomized studies (MINORS) for CCTs and Cochrane's risk of bias tool for RCTs were applied. The certainty of the evidence was evaluated according to the grading of recommendations, assessment, development, and evaluation (GRADE) approach., Results: Nine studies (6 RCTs and 3 CCTs) were included in this review, and six of them were appropriate for quantitative synthesis. The meta-analysis revealed that the quad-helix (QH) was more effective than expansion plates (EP) in increasing the intermolar width (WMD = 1.25; 95% CI 0.75, 1.75; P < 0.001), and decreasing treatment time (WMD = - 3.36; 95% CI - 4.97, - 1.75; P < 0.001). The relapse rate at 5.6 years post-treatment was greater in the QH group than in the EP group (RR = 3.00); however, the difference was statistically insignificant. There was no significant difference between the QH and the EP in other outcome measures. When assessing the rapid maxillary expansion (RME), only one RCT compared the RME with an untreated control group and reported a significant increase in the maxillary intermolar and intercanine width (P < 0.001, P = 0.002, respectively) and a significant decrease in lower midline deviation (P < 0.001)., Conclusion: There is weak to moderate evidence that the treatment of functional posterior crossbite (FPXB) by the QH increased the maxillary intermolar width and the success rate and decreased the treatment duration compared to the EP. The relapse percentage was greater in the QH group. There is very weak evidence that the mandibular midline correction rate did not differ significantly between the QH and the EP modalities. The RME using the Hyrax appliance corrected the FPXB successfully; however, the strength of evidence in this regard is very low. As the quality of evidence ranged from very low to moderate in this review, we confirm the need for more RCTs with different expansion appliances in the early treatment of FPXB., (© 2022. The Author(s).)

Introduction: The lengthy period of time required is one of the main reasons patients refuse orthodontic treatment. In addition, treatment may have negative effects on periodontal tissues., Objective: This study aimed to evaluate the overall time needed for leveling and alignment and the periodontal indices in adult patients with severe crowding. Patients were treated using either self-ligating brackets associated with flapless corticotomy (SLBs + FC group), self-ligating brackets alone (SLBs group), or conventional brackets (CBs group) alone., Materials and Methods: A total of 57 adult patients (10 male patients, 47 female patients) referred to the Department of Orthodontics, the University of Damascus Dental School from August 2018 to March 2019, were enrolled in this trial. The patients were randomly allocated to 1 of 3 groups: CBs (mean age: 19.62 ± 2.42 years), SLBs (mean age: 19.98 ± 2.84 years), or SLBs + FC (mean age: 20.67 ± 2.59 years). The overall alignment time for the upper anterior teeth was calculated. The following periodontal parameters were measured at 5 assessment times: plaque index, gingival index, papillary bleeding index, and probing depth., Results: The average leveling and alignment time was 81.89 ± 9.49 days, 123 ± 10.69 days, and 165.25 ± 13.05 days for the SLBs + FC group, the SLBs group, and the CBs group, respectively. A significant reduction in the overall alignment duration was found in the SLBs + FC group by 50%, and in the SLBs group by 25%, compared to the control group, with a statistically significant difference among the 3 groups (P < 0.001). There were statistically significant differences in the periodontal indices (except probing depth) after 1 month, with values greater in the SLBs + FC group (P < 0.05)., Conclusions: Using self-ligating brackets in combination with flapless corticotomy may be effective in accelerating upper dental decrowding in adult patients, with a reduction of 50% of the normal treatment time using traditional brackets. Using self-ligating brackets alone reduced treatment time by 25%. The adjunctive flapless corticotomy did not cause clinically negative effects on the periodontal tissues., (Copyright © 2021 World Federation of Orthodontists. Published by Elsevier Inc. All rights reserved.)

Introduction: No randomized controlled trial (RCT) has compared flapless corticision with the conventional treatment in the non-extraction treatment of crowded lower anterior teeth (LAT) in terms of external apical root resorption (EARR) and dehiscence formation (DF). The aim of this RCT was to investigate these two complications during levelling and alignment of the LAT using cone-beam computed tomography (CBCT) imaging., Methods: Patients with mild to moderate crowding of the LAT were included. Subjects were randomly allocated to either the corticision-assisted orthodontic treatment group (CORT) or the traditional orthodontic treatment group (TRAD). In the CORT, three vertical incisions were performed after brackets' placement. CBCT images were taken before starting treatment and after treatment completion to assess the EARR and the DF. Two-sample t-test and Chi-Square tests were used to detect significant differences., Results: In general, 312 roots of the lower anterior teeth (156 in each group) were examined. Fifty-two patients (14 males and 38 females, mean age 21.38) were recruited. (CORT; n=26, 6 males, 20 females, mean age 21.30); (TRAD; n=26, 8 males, 18 females, mean age 21.46). No statistically significant difference was found between the two groups regarding the overall mean value of EARR following alignment (P=0.436). The greatest recorded resorption values were 0.81 and 1.02 in the CORT and TRAD groups, respectively. At the end of levelling and alignment, there was no statistically significant difference between the two groups regarding the distribution of DF (P=0.780)., Conclusion: Corticision as an acceleration technique did not produce any significant side effects on the roots of lower anterior teeth and did not cause additional alveolar bone defects (dehiscence formation) compared to the conventional non-accelerated method of alignment., (Copyright © 2021 CEO. Published by Elsevier Masson SAS. All rights reserved.)

Background: No randomized controlled trial (RCT) has compared flapless piezocision-assisted corticotomy in the extraction-based orthodontic decrowding of lower anterior teeth with the conventional treatment., Objective: To evaluate the effectiveness of flapless piezocision-assisted corticotomies in accelerating lower anterior teeth alignment., Trial Design: A parallel-group RCT was conducted., Materials and Methods: Thirty-six patients (mean age 20.32 ± 1.96 years) in need of orthodontic treatment with a fixed orthodontic appliance were enrolled and randomly allocated to either the experimental or the control group. Following first premolar extraction, five radiographic-guided micro incisions and localized piezoelectric corticotomies were performed on the labial surfaces of the alveolar bone between the six anterior teeth in order to accelerate alignment for patients in the experimental group, whereas those in the control group received traditional orthodontic treatment. The overall alignment time (OAT) required to complete anterior alignment of the mandibular dental arch (OAT) was measured. Little's Irregularity Index (LII) was also calculated at monthly intervals. Randomization was performed using a software-generated list of random numbers; the recruited patients were divided into two parallel groups with a 1:1 allocation ratio. Assessor blinding was employed., Results: One hundred and eight severe dental crowding patients were evaluated for eligibility, 40 of them fulfilled the inclusion criteria. Thirty-six participants were allocated to the treatment groups randomly. One female patient was lost to follow-up from the control group, and another female patient was excluded from analysis for the experimental group. Accordingly, the results of 34 patients were statistically analyzed. OAT was reduced by 59% in the experimental group compared to the control group, with a statistically significant difference between the two groups (P < 0.001). No harms were encountered., Conclusion: Flapless piezocision technique was very effective in accelerating orthodontic tooth movement., Trial Registration: This trial was registered at Clinical Trials.gov (Identifier: NCT02977221)., (© The Author(s) 2018. Published by Oxford University Press on behalf of the European Orthodontic Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Aim: To evaluate the efficacy of accelerated and non-accelerated methods of en-masse retraction of the upper anterior teeth in terms of skeletal, dental, and soft-tissue variables, as well as the duration of retraction or overall orthodontic treatment., Materials and Methods: An electronic search of PubMed and nine other major databases for randomized controlled trials (RCTs) and clinical controlled trials (CCTs) was performed between January 1990 and April 2018. The bibliography in each identified article was reviewed. In addition, manual searching was performed in the same time frame in five major orthodontic journals.The participants were patients over 14 years old undergoing fixed orthodontic treatment with extraction of maxillary or bimaxillary premolars followed by en-masse retraction of maxillary anterior teeth in both groups. Cochrane's risk of bias tool for RCTs and methodological index for non-randomized studies (MINORS) for CCTs were used., Results: Eight articles (six RCTs and two CCTs) were included in this review, and only five articles were suitable for quantitative synthesis. The en-masse retraction caused a decrease in the SNA and ANB angles with no significant differences between the different en-masse retraction methods. Using temporary skeletal anchorage devices (TSADs) gave significantly better results in terms of posterior anchorage in comparison with conventional anchorage(standardized mean difference (SMD) = -3.03 mm, p < 0.001). No significant difference was found between en-masse/flapless corticotomy and en-masse/control groups in terms of anterior teeth retraction ( p = 0.661); while there was a significantly greater anterior teeth retraction in corticotomy with flap elevation group compared to control group ( p < 0.001)., Conclusion: There is a weak to moderate evidence that using accelerated and non-accelerated methods would improve the facial profile and lead to similar skeletal corrections. There is weak to moderate evidence that using TSADs would lead to better posterior anchorage than using conventional anchor-age.Moderate evidence was found regarding the benefit of using piezosurgery in achieving good incisors' inclination. Contradictory results were found regarding the amount of achieved anterior retraction and the retraction time in the studies that evaluated acceleration methods versus the traditional methods of retraction. According to the quality of evidence, there is a need for more well-conducted RCTs, and more work to be oriented towards en-masse retraction with the use of other acceleration methods., Clinical Significance: The correction of the maxillary or bimaxillary dentoalveolar protrusion by en-masse retraction of the upper anterior teeth with/without acceleration is accompanied by aesthetic results in the facial soft tissues as well as in the underlying skeletal and dental structures. The traditional corticotomy-assisted retraction is expected to reduce the retraction time significantly. However, the strength of evidence is not strong and requires additional research work.

Background: Hawley retainers (HRs) and vacuum formed retainers (VFRs) are the most commonly used removable retainers in the orthodontic practice. Patients' cooperation in wearing these appliances is affected by the levels of discomfort and oral impairment. The evidence regarding their acceptably among orthodontic patients is limited., Aims: To compare the acceptability of HRs and VFRs over a 6-month period in a group of fixed orthodontic patients., Trial Design: Two-arm parallel-group randomized controlled trial., Methods: Patients being treated at the Orthodontic Department of Saudi Swiss Consultant Dental Centre, Al-Khobar, Saudi Arabia, who met the inclusion criteria were invited to participate. Inclusion criteria were treatment only with fixed appliances, no lateral expansion treatment, no hypodontia, no cleft lip and palate, no surgical corrections, no extraction-based plans, 18 years old or greater, and willingness to wear maxillary and mandibular removable retainers. Participants were distributed randomly using concealed envelopes into two groups: HR group and VFR group. A pilot-tested questionnaire was filled at three times: 1 week after fitting of the retainer (T1), 3 months and 6 months following appliance fitting (T2 and T3, respectively). Ten questions were given on biting, fitting of the appliance, speech, appearance, oral hygiene, durability, gingival irritation, swallowing, self-confidence, and comfort. Responses were given on a visual analogue scale. Blinding was employed during data analysis., Results: Ninety-four patients were included primarily. Six patients in the Hawley group and two patients in the VFR group failed to complete the study. Therefore, 86 patients were included the analysis (HR group: 41; VFR group: 45). No significant differences were found between the two groups in biting, fitting of the appliance, and hygiene perception, whereas significant differences were detected in speech (P < 0.05), appearance (P < 0.001), gingival irritation (P < 0.001), durability (P < 0.001), swallowing (P < 0.001), self-confidence, and comfort (P < 0.001). No harm to any patient was noticed during the trial., Conclusions: Over a 6-month period of retention, VFR was significantly more acceptable than HR in speech, appearance, gingival irritation, swallowing, self-confidence, and comfort. Subjects in the HR group believed that their retainers were significantly more durable than those in the VFR group at the final assessment. Both retainers were equal regarding fitting of the appliance, biting, and hygiene perception., Registration: Not registered., Protocol: The protocol was not published before trial commencement., Funding: This trial was funded by the Saudi Swiss Consultant Dental Centre., (© The Author 2017. Published by Oxford University Press on behalf of the European Orthodontic Society. All rights reserved. For permissions, please email: journals.permissions@oup.com)

Introduction: Few studies utilized cone beam computed tomography (CBCT) to evaluate soft tissue dimensions in malocclusion patients. The aim of this study was to analyze the three-dimensional (3D) soft tissue relationships of adult patients according to their gender and skeletal sagittal class using CBCT Materials and methods: The study sample consisted of 96 CBCT images of patients of both genders; aged 18 to 25 years with a normal vertical skeletal pattern. Patients were segregated into three groups according to their skeletal sagittal class: Class I (2 < ANB < 4), class II (ANB > 4), and class III (ANB < 2). The soft tissue measurements were analyzed in both the sagittal views and frontal volumetric rendered views using 3D-OnDemand software., Results: In males, the measurements (U1-stom, nasal width, mouth width) were greater in class I than in class II group. Lower lip thickness was greater in class I than in class III group (p < 0.05). In females, both labiomental fold thickness and upper lip height measurements showed greater mean values in class II than in class I group. In contrast, lower lip height was greater in class I than in class III group. Ls-Pr, U1-stom, and face width at Cheilion revealed greater values in class III patients than in class II patients. On the other hand, the lower lip thickness, upper lip height, and lower lip height measurements showed greater values in class II than in class III group (p < 0.05). Soft tissue thicknesses and measurements were greater in males than in females. However, statistically significant differences between the two sexes were not detected for all of the variables measured in each skeletal class., Conclusion: The current study indicates the presence of differences in soft tissue thicknesses and facial soft tissue dimensions among skeletal classes and between the two sexes., Clinical Significance: Cone beam computed tomography imaging is a very valuable tool to analyze 3D soft tissue characteristics of patients with different skeletal patterns of malocclusion.

Background and Objectives: New studies have been published and aimed to retract canines by means of distraction osteogenesis to reduce treatment time. Although a great care has been given to achieve a bodily movement of the canines, a significant amount of tipping of the canines has been observed. This trial aimed to assess the effect of applying a modified distractor on canine angulation., Materials and Methods: The sample of the study consisted of 14 canines in seven patients (16-25 years). After the osteotomy procedure, two distractors were applied (one distractor on each side). After 5 days of a latency period, the two distractors were activated at a rate of 1 mm/day., Results: There was a significant difference between the two distractors regarding the time required to retract the canines (p = 0.008) and the observed change in canine angulation following retraction (p = 0.028). The change in the overjet and the mandibular plane angle was statistically insignificant. Eight out of 14 distracted canines reacted positively to the pulp vitality tester after 3 months of completion of distraction. There was no clinical sign of discoloration or pulpal pain in any canine., Conclusion: Within the limits of this study, the modified distractor caused a bodily movement of the canine with a minimal tipping. Further research is required on a long-term basis on a larger group of patients to gain more insight on the observed changes.

Objectives: To evaluate the bone thickness and density in the lower incisors' region in orthodontically untreated adults, and to examine any possible relationship between thickness and density in different skeletal patterns using cone-beam computed tomography (CBCT)., Materials and Methods: The CBCT records of 48 patients were obtained from the archive of orthodontic department comprising three groups of malocclusion (class I, II and III) with 16 patients in each group. Using OnDemand 3D software, sagittal sections were made for each lower incisor. Thicknesses and densities were measured at three levels of the root (cervical, middle and apical regions) from the labial and lingual sides. Accuracy and reliability tests were undertaken to assess the intraobserver reliability and to detect systematic error. Pearson correlation coefficients were calculated and one-way analysis of variance (ANOVA) was employed to detect significant differences among the three groups of skeletal malocclusion., Results: Apical buccal thickness (ABT) in the four incisors was higher in class II and I patients than in class III patients (p < 0.05). There were significant differences between buccal and lingual surfaces at the apical and middle regions only in class II and III patients. Statistical differences were found between class I and II patients for the cervical buccal density (CBD) and between class II and III patients for apical buccal density (ABD). Relationship between bone thickness and density values ranged from strong at the cervical regions to weak at the apical regions., Conclusions: Sagittal skeletal patterns affect apical bone thickness and density at buccal surfaces of the four lower incisors' roots. Alveolar bone thickness and density increased from the cervical to the apical regions.

Objectives: (1) To evaluate the applicability of using 3D digital models in the assessment of the magnitude of occlusal contacts by measuring occlusal contact surface areas (OCSAs) and 3D mesh points in 'contact' (OCMPs) in a sample of orthodontic patients; (2) To detect any sex differences in the magnitude of occlusal contacts in all malocclusion groups; (3) To detect inter- group differences; (4) To assess possible correlations between occlusal contacts and other dental characteristics., Materials and Methods: Study casts of 120 malocclusion patients were selected and divided into 4 groups (class I division 1, class II division 1, class II division 2, class III) with equal numbers for both sexes. 3D digital models were produced using O3DM™ technology. Occlusal contacts were quantified using two methods of measuring., Results: (1) No significant sexual differences were detected for OCMPs (mesh points) and OCSAs (mm(2)) in all groups. (2) There were statistically significant differences among malocclusion groups for OCMPs and OCSAs (p < 0.001). Tukey's HSD post- hoc tests showed that class III patients had significantly less occlusal contacts than other malocclusion groups. (3) Stepwise multiple regression equations showed that overjet, lower arch width and overbite could explain approximately 19.5% of the total variance of OCSAs and OCMPs., Conclusion: Sexual differences in occlusal contacts were not detected. Class I division 1 patients had the highest amount of occlusal contacts among all groups of malocclusion. Overjet, overbite and lower dental arch width were best predictors of occlusal contacts in the current sample.

We developed a new three-dimensional (3D) method of analysis of facial asymmetry and applied it to 44 patients: 20 Class III cases treated by bimaxillary osteotomy; 12 Class III cases treated by maxillary advancement alone, and 12 Class II cases treated by bimaxillary operations. 3D images were taken within a week before operation (T1), and one (T2), three (T3), and six (T4) months after operation. Landmarks were digitised on each 3D model and facial asymmetry scores were calculated. In the bimaxillary osteotomy group, facial symmetry improved after operation. In the maxillary advancement group, there was no notable improvement in facial symmetry after operation. In the bimaxillary group, facial symmetry deteriorated after operation, particularly at the tip of the nose and prominence of the chin. At six months follow-up, the changes in facial asymmetry in the three groups were not significant.

Aims: This study aimed to evaluate the short-term oropharyngeal airway volumetric changes in growing Class III maxillary-deficient patients treated by facemask without expansion compared with untreated Class III controls, using low-dose computed tomography. Methods: Eighteen maxillary-deficient children (9 boys, nine girls) with a mean age of 7.81 ± 0.84 years were treated with maxillary bonded bite block and facemask (FM). Pre- (T1) and post-treatment (T2) low-dose CT images were acquired. Sixteen untreated Class III patients with a mean age of 7.03 ± 0.56 years had previously two low-dose CT scans within a one year of follow-up. Volumetric and minimal cross-sectional area measurements were obtained to assess the oropharyngeal airway changes. Quantitative mean, minimum, and maximum displacement of superimposed 3D models were estimated from a point-based analysis. Paired-samples t-tests were used for the intragroup comparisons, and an independent samples t-test and the Mann–Whitney U tests were carried out for the intergroup comparisons. Results: A statistically significant increase in the total and retropalatal volumes oropharyngeal airway volume were observed in the control group (302.23 ± 345.58 and 145.73 ± 189.22 mm3, respectively). In the FM group, statistically significant increases in the total and retropalatal volumes were observed (738.86 ± 1109.37 mm3 and 388.63 ± 491.44 mm3, respectively). However, no statistically significant differences were found between the two groups, except for the maximum part analysis which was significantly greater in the FM group (p = 0.007). Conclusions: FM therapy appeared to have no additional effects on the oropharyngeal airway other than those induced by growth. [ABSTRACT FROM AUTHOR]

Introduction: Bone-Anchored Intermaxillary Traction (BAIMT) is a relatively new method for class III treatment in growing patients, therefore evidence about their acceptably as well as the levels of pain, discomfort and functional impairments among orthodontic patients is still lacking. Aim: To evaluate levels of pain, discomfort and acceptance between the BAIMT system and a commonly used treatment modality in the correction of Class III malocclusion. Materials and Methods: Two-arm parallel-group randomised controlled trial was conducted at the Department of Orthodontics, Al-Baath University Dental School. Fifty-six patients who met the inclusion criteria were distributed randomly and equally into two groups: the bone-anchored intermaxillary traction group (the BAIMT group with a mean age of 11.3 years) and the removable mandibular retractor group (the RMR group with a mean age of 11.5 years). A special questionnaire (originally designed by Sergl) was used and included six questions regarding patients' feelings of appliancerelated tension/pressure, pain, impaired speech, swallowing difficulty, oral constraint and lack of confidence in public. This questionnaire was administered at T1 (1 day), T2 (1 week), T3 (6 weeks), T4 (3 months) and T5 (6 months) following appliance initial wear. Results: Fifty-one patients were included in the analysis (BAIMT group: 26; RMR group: 25). Patients treated with the BAIMT system had higher levels of pressure, tension (p<0.001) and pain (p<0.001) compared to those in the control group. No statistically significant differences were found between the two groups in relation to impaired swallowing, whereas the RMR caused more constraint in mandibular movements (p<0.05) and more speech impairment (p<0.001) in addition to increased levels of lack of confidence (p<0.001). Conclusion: The BAIMT system caused more pain than the RMR but the levels of pain gradually decreased especially after one week following application. RMR caused more mandibular restriction and more speech impairment because of the presence of the reverse bow, and it caused relatively high levels of social avoidance and lack of confidence for the patient. [ABSTRACT FROM AUTHOR]

Background Increased awareness on the role of oral functions in the aetiology of Class II deformities has led to the wide spread of myofunctional training appliances as easy and possibly effective treatment for children with Class II malocclusion but their efficacy is yet to be proven. Objectives To evaluate soft- and hard-tissue changes following 12 months of Class II division 1 treatment in growing patients with a conventional functional appliance (a modified Activator) versus a myofunctional Trainer system (T4K ® ). Setting and sample population Department of Orthodontics, Dental School. Participants, study design, and methods Sixty Class II division 1 children (8–12 years old) were recruited from primary schools and were distributed randomly into two equal groups. Randomization was based on a computer-generated sequence of random numbers. Data analysis included: the Activator group (28 patients, mean age = 10.6 ± 1.3 years); the T4K ® group (26 patients, mean age = 10.3 ± 1.4 years). Skeletal, dentoalveolar, and soft tissues changes were assessed using standardized lateral cephalograms collected before and after 12 months of treatment. No blinding was applied in this trial. Results Improvement in the Class II skeletal and dentofacial characteristics were significantly greater in the Activator group when compared with the T4K® group. The improvement was evident in a significant decrease in the skeletal angle ANB with Activator (⁠ x ¯ = −1.89 ± 1.12) compared to T4K® (⁠ x ¯ = −0.9 ± 1.01) (P = 0.01), a significant greater increase in the facial convexity angle with Activator (⁠ x ¯ = 2.61 ± 3.71) more than T4K® (⁠ x ¯ = 0.2 ± 2.51) (P = 0.04), and a significant reduction in the overjet (⁠ x ¯ = −3.0 ± 2.3 mm) compared to (⁠ x ¯ = −1.5 ± 1.9 mm; P = 0.01) with Activator versus T4k®, respectively (P = 0.001). Limitations This study was a short-term study (12-month follow-up). Conclusions The results of the current study indicated that the Activator was more effective than the T4K® in treating Class II division 1 growing patients. Registration The trial was not registered in any major database of clinical trials. Protocol The protocol was not published before the commencement of the trial but can be given upon request. [ABSTRACT FROM AUTHOR]