Powerscope

Powerscope
The Mandbular propellor

The Assessment of Sagittal Changes with Powerscope

Appliance with Class II Div 2 malocclusion in Decelerating
Growth Phase

S. Gowri sankar 1
Powerscope

Dr. S. GOWRI SANKAR M.D.S

professor
Department. of Orthodontics
Narayana Dental College
NELLORE.—A.P.
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Powerscope

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Powerscope

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Powerscope

Class II Div 2 malocclusion

 The Prevalence of class 2 div 2 malocclusion is 1.1% in

males and 5.0% in females in India.
 Retroclination of two or more maxillary incisors
 A class 2 molar relationship and an increased overbite.
 Functional locking of mandibular growth due to
retroclination of the maxillary incisors worsening the
class II skeletal relation ship
 Backward shift of the condyle and backward path of
closure

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Powerscope
 A definite relationship exists between this so-called unlocking
of deep bite malocclusions and increased mandibular dento
alveolar or skeletal growth and mostly in class 2 division 2
cases. It is expected that there will be unlocking of mandible as
deep bite is corrected.(Woods 2008)

 craniofacial growth does not stop in young adulthood but is a

continuous process even into later ages. Behrents (1985)

 The range of likely sagittal changes of mandible following deep

overbite correction in class 2 div 2 patients with decelerating
stage of growth can be propelled by a powerful bite jumping
appliance

Woods MG. Sagittal mandibular changes with overbite correction in subjects with different mandibular growth directions: Late mixed-dentition treatment effects. Am J Orthod
Dentofacial Orthop. 2008;133(3):388-94.

Behrents R. G. Growth in the Aging Craniofacial Skeleton. Ann Arbor, Mich, USA: entre for Human Growth and Development, University of Michigan; 1985. (Craniofacial Growth
Series-Monograph 17).
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Powerscope

Class II Div 2 malocclusion

 The Prevalence of class 2 div 2 malocclusion is 1.1% in

males and 5.0% in females in India.
 Retroclination of two or more maxillary incisors
 A class 2 molar relationship and an increased overbite.
 Functional locking of mandibular growth due to
retroclination of the maxillary incisors worsening the
class II skeletal relation ship
 Backward shift of the condyle and backward path of
closure

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Powerscope

 Latest innovation for treatment of class II skeletal

malocclusions in noncompliant patients along with fixed
appliance is PowerScope.

 Unique features are patient-friendly design, Different

securing mechanism to the archwire.
 It has a simple attachment system with durable telescopic
mechanism, a Ni–Ti internal spring system ready to use one
piece
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Powerscope

 One appliance which fits all

 No additional laboratory procedures- can be
completed chair side in single appointment
 Lateral movements are not compromised with ball
and socket joint system increasing patient comfort

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Powerscope

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Powerscope Previous studies
Vinni Aroraa et al ( 2018) Compared the treatment effects of
Forsus ™ and Powerscope ® in class II div I patients in actively
growing patients . The forward movement of the mandibular
molar and incisors were greater in the PowerScope patients (2.3
mm and 2.80 mm) than in the Forsus patients (1.9 mm and 2.38
mm). Dentoalveolar changes are more with Powerscope. Both
PowerScope and Forsus are effective in correcting Class II
malocclusion

Nishanth et al ( 2017) conducted a study on subjects between 11

and 16 years with class I Div I malocclusion to evaluate the
skeletal, dentoalveolar, and soft-tissue changes and condyle-
glenoid fossa relationship after using the Powerscope. They
stated that PowerScope was clinically efficient in the correction
Woods MG. Sagittal mandibular changes with overbite correction in subjects with different mandibular growth directions: Late mixed-dentition treatment effects. Am J Orthod
Dentofacial Orthop. 2008;133(3):388-94.

of Class II malocclusion in noncompliant patients.

Behrents R. G. Growth in the Aging Craniofacial Skeleton. Ann Arbor, Mich, USA: entre for Human Growth and Development, University of Michigan; 1985. (Craniofacial Growth
Series-Monograph 17).
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Powerscope

• Antony et al ( 2018)—Age group of 15-19 years --Results

showed that there is significant sagittal forward growth of
the mandible. Cohort group is class II div I patients

• Malhotra etal (2018) – Adolescents with CVMI Stages 5

and 6. There is significant lengthening of the mandible and
the changes brought about by the Powerscope are both
dentoalveolar and skeletal in nature

• Vinni Aroraa ; Rekha Sharmab ; Sonal Chowdhary c . Comparative evaluation of treatment effects between two fixed functional appliances for correction of Class II
malocclusion: A single-center, randomized controlled trial. Angle Orthod. 2018;88:259–266.
• Antony T, Amin V, Hegde S, Hegde S, Shetty D, Khan MB. The evaluation and clinical efficiency of PowerScope: An original research. J Int Soc Prevent Communit Dent
2018;8:264-70
• Nishanth B, Gopinath A, Ahmed S, Patil N, Srinivas K, Chaitanya A. Cephalometric and computed tomography evaluation of dentoalveolar/soft-tissue change and alteration
in condyle-glenoid fossa relationship using the PowerScope: A new fixed functional appliance for Class II correction –A clinical study. Int J Orthod Rehabil 2017;8:41-50
• Malhotra A, Negi KS, Kaundal JR, Negi N, Mahajan M, Chainta D. Cephalometric evaluation of dentoskeletal and soft-tissue changes with powerscope Class II corrector. J
Indian Orthod Soc 2018;52:167-73

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Powerscope Aims and objectives
 The aim of this cephalometric study was to study the
efficacy of powerscope® (TM) in subjects with
skeletal class II division 2 malocclusion

The objectives included

• To determine the amount, time, and rate of molar

correction.
• To determine the skeletal changes in the Maxillary and
Mandibular base
• To determine the dentoalveolar changes in the Maxillary
and Mandibular arches
• To distinguish the skeletal and dental corrections in the
mandible achieved
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Powerscope
Materials and Methods
The Subjects of the study

• Registered for Orthodontic Treatment in the post graduate

Department of Orthodontics, Narayana Dental College,
Nellore, Ap, India.

• Ethical clearance from Insititutional Regulatory Board was

obtained

• Treatment procedures are explained and a written consent

in taken

• All the materials and procedures in the study are well

established for their safety modality

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Powerscope

Inclusion criteria
 Age of the patient 14-18 years who are under decelerating
growth phase as assessed by CVMI 5 and CVMI 6 stages-
only 10-20 % growth remaining.
 Full complement of teeth excluding third molars with at
least 5mm class 2 first permanent molar relationship on
each side.
 Class II skeletal relation as assessed by Wits appraisal
 Retroclination of Upper Incisors with overjet of less than
2mm
 Mandibular crowding was no greater than 2mm.
 All patients had incisal overbites of at least 5mm (or) 50%
of skeletal criteria.

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Powerscope

Exclusion criteria:
 Patients with pain and clicking sounds in the
temporomandibular joint.
 Patients having moderate to severe periodontal
problems.
 Patients whose growth is completed.
 Patients with hyperdontia, hypodontia, or
syndromic diseases (cleft lip and cleft palate).
 Patients with severe transverse (or)vertical
problems.
 Missing teeth

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Powerscope

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Powerscope

ARMAMENTARIUM
• Standard MBT™ Masters series, American
Orthodontics, Sheboygan, Wis) Bracket
prescription (0.022 inch slot)
• Power Scope kit containing:
right arm/left arm
Crimpable shims (2 and 3 mm)
Hex head driver
Replacement attachment.
• Nitinol and Rectangular stainless steel
archwires (0.019” × 0.025 inch)
• Ligature wire (0.009 inch)
• Lateral cephalogram.

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Powerscope Clinical steps
Standard MBT (Masters series, American Orthodontics,
Sheboygan, Wis) brackets with 0.022 X 0.028 slot was bonded
on the upper and lower arches to align the teeth.

Alignment and incisor inclination correction was brought

about by using 0.014-inch NiTi archwire,0.018-inch NiTi,
followed by 17x25-inch NiTi and 19x25-inch NiTi archwires
respectively.

Upper and lower arches were stabilized using the 19x25 SS

wire with TPA and Lingual arch in Upper and Lower arches
before proceeding to the Powerscope application

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Powerscope

Attachment of Powerscope and follow up

• PowerScope (American Orthodontics, Sheboygan, Wis) was
attached to the archwire distal to mandibular canine and
mesial to maxillary first molars on both sides

• Regular follow-up at 1-month interval was done.

• Lateral cephalograms were taken just before the placement

of PowerScope (T1) and after its removal (T2) after
attaining a class I molar relation ship.

• These cephalograms were analysed for skeletal and

dentoalveolar changes and from T1 to T2 using various
cephalometric parameters
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Powerscope
Pretreatment

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Powerscope
POWER SCOPE INSERTION
Powerscope
POST ALIGNMENT

T1
Powerscope
PRE TREATMENT

T2

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Powerscope STEINERS ANALYSIS

MEAN/SD PRE MID POST

SNA 82º±2 85° 85 86

SNB 80º±2 79° 79 83

SND 76º 78° 74 82

ANB 2º±2 6° +6 +3

Go-Gn to SN 32º±4 22° 20 19

UI to NA (mm) 4mm 5 mm 8.5 mm 4 mm

UI to NA (angle) 22º 11°,37°(24°) 41 32

LI to NB (mm) 4mm 4 mm 9 mm 7 mm

LI to NB (angle) 25º 12°,27°(20°) 35 25

Interincisal Angle 131º 108°(130°) 96 117

Occl. to SN angle 14º 15° 11 7

Powerscope MCNAMARA ANALYSIS

MEAN/SD PRE MID POST

N Perpendicular to Pt. A 0±2mm -1 mm +2 mm +1.5 mm
N Perpendicular to 0to -4mm -8 mm -4 mm - 4 mm
Pogonion
Facial Axis angle 0º -1° -3 +1
Mandibular Plane angle 26±4º 20° 16 17
Eff. Max. Length 95.2 + 3.2 89 mm 90 mm 90 mm
Eff. Mand. Length 120.6 ± 4.3 mm 106 mm 112 mm 113 mm
Maxillofacial Differential 25.4+3.5mm 17 mm 22 mm 23 mm
Lower Ant. Face Height 66.8+3.9 57 mm 61 mm 58 mm
(LAFH)
U1 to Point A distance 4mm 4 mm 9 mm 6mm
L1 to APog line distance 1-2mm -3 mm +2.5 mm 2mm
Naso Labial angle 90-110º 115° 95 112
Powerscope RAKOSI JARABAKANALYSIS

MEAN/SD PRE MID POST

Saddle angle 123±5º 124° 120 117
Articular angle 143±6º 152° 155 153
Gonial angle 128±7º 107° 110 11
Upp.Gonial angle 52-55º 44° 43 47
Low.Gonial angle 72-75º 63° 67 64
Sum of posterior angles 396±6º 383° 385 381
Mandibular Plane angle 32º 23° 23 19
Angle of Inclination 85º 85° 88 87

Pn to Occlusal plane 75º 83° 88 88

Pn to Mandibular plane 65º 75° 76 73
Basal Plane angle 25º 11° 12 10
Powerscope

MEAN/SD PRE MID POST

Palatal plane to Occl. 11º 4°

0 -2
Plane
Occl. Plane to MP 14º 8°
12 12

Jarabak ratio:(ant. to 62-65% 73.21%

75.2% 75.8%
post. Face ht. ratio)
Y-Axis 66º 65° 66 61
Interincisal angle 135º 108°(130°)
96 117

U1 to SN plane 102 ± 2º 124°(110°) 108 122

U1 to Palatal plane 70º ± 5º 45°(58°) 43 48
L1 to Mandibular 90 ± 3º 105°(97°)
116 102
plane
Powerscope RICKETTS ANALYSIS

MEAN/SD PRE MID POST

Facial Axis angle 90 ± 3.5º 89°

(Ba.Na-Ptm.Gn’)
93 89

Facial Depth (N.Pog-FH) 87 ± 3º 85°

88 87

M.P.angle (Go’.Gn’-FH) 26 ± 4.5º 18° 13 14

Convexity of Pt.A. 2 ± 2mm +5 mm +4 mm +3.5 mm
L1 to A.Pog (angle) 22 ± 4º 24°(15°)
33 21

L1 to A.Pog (mm) 1 ± 2mm -2 mm 2.5 mm 2 mm

U6 to PtV Age +3mm 9 mm

(19+3=22) 13 mm 12 mm

L.Lip to E- plane -2+2 -3 mm

-2 mm -2.5 mm
Powerscope BURSTONE HARD TISSUE ANALYSIS

MALE FEMALE PRE MID POST

CRANIAL BASE
Ar-Ptm (// Hp) 37.1±2.8 32.8±1.9 35 mm 35 mm 35 mm
Ptm-N (//Hp) 52.8±4.1 50.9±3 48 mm 50 mm 47 mm

HORIZONTAL
N-A-Pg (angle) 3.9º±6.4º 2.6º±5.1º +12° 8 3
N-A (//Hp) 0.0±3.7 -2±3.7 +3 mm +1 mm 6 mm
• N-B (//Hp) -5.3±6.7 -6.9±4.3 -7 mm -7.5 mm 1.5 mm
• N-Pg (//Hp) -4.3±8.5 -6.5±5.1 -2 mm -5 mm 3.5 mm

VERTICAL
N-ANS (Hp) 54.7±3.2 50±2.4 57 mm 56 mm 53mm
• ANS-Gn (Hp) 68.6±3.8 61.3±3.3 54 mm 58 mm 58 mm

PNS-N (Hp) 53.9±1.7 50.6±2.2 52 mm 48 mm 47 mm

Mp-Hp (Angle) 23.0º±5.9º 24.2º±5º 16° 16 12
Powerscope Comparison of pre and post powerscope
Powerscope
The SO ( Saggital occlusal) – Analysis
(Pancherz 1982)
• Excellent in predicting the alterations in sagittal occlusion
(overjet, molar relationship)

• Differentiates between skeletal and dental components in the

maxilla and mandible.

• A reference grid comprising an occlusal reference line (RL) and a

line perpendicular to that through sella (RLp).

• The first head film Post treatment head films are compared by
superimposition on nasion-sella line (NSL) with sella as a
common registration point. All measurements were done parallel
to RL.
Powerscope
Powerscope
• is/RLp minus ii/RLp – Overjet.
• ms/RLp minus mi/RLp – Molar relation (a positive value indicates a
distal relation; a negative value indicates a normal relation).
• ss/RLp – Position of the maxillary jaw base.
• pg/RLp – Position of the mandibular jaw base.
• is/RLp – Position of the maxillary central incisor.
• ii/RLp – Position of the mandibular central incisor.
• ms/RLp – Position of the maxillary permanent first molar.
• mi/RLp – Position of the mandibular permanent first molar

• Changes in the different measuring points in relation to RLp

occurring during the examination period were registered by
calculating the difference (d) in landmark position.

• Changes in variables 3 and 4 represent skeletal changes, while

changes in variables 5 to 8 represent a composite picture of
skeletal and dental changes
Powerscope

• is/RLp(d) minus ss/RLp(d) – Change in position of the maxillary

central incisor within the maxilla.
• ii/RLp(d) minus pg/RLp(d) – Change in position of the mandibular
central incisor within in mandible.
• ms/RLp(d) minus sp/RLp(d) – Change in position of the maxillary
permanent first molar within the maxilla.
• mi/RLp(d) minus pg/RLp(d) – Change in position of the mandibular
permanent first molar within the mandible.

Pancherz Hanz. A cephalometric analysis of skeletal and dental changes contributing to class II correction in activator treatment. Am J Orthod
Dentofacial rthop. 1984;74:125–34.

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 Powerscope Measured Parameters

Comparison of Pre-treatment powerscope and Post-treatment Powerscope

(SO-Analysis)Student’s “t”-test.

Pre-treatment Post treatment

Parameters/
Powerscope (T1) Power Block (T2) p-value
Linear Measurements
Mean S.D Mean S.D
Maxillary Base (ss/RLp) 82.26 3.45 80.78 3.25 0.022*
Mandibular Base (pg/RLp) 76.60 2.94 81.48 2.85 0.00***
Maxillary incisor (is/RLp) 85.33 2.69 84.73 3.89 0.054*
Mandibular incisor (ii/RLp) 79.36 3.43 84.30 3.18 0.012**
Maxillary Molar (ms/RLp) 52.42 3.57 51.24 3.56 0.055*
Mandibular molar (mi/RLp) 50.40 3.23 55.60 2.95 0.014**
Overjet 8.74 0.88 2.20 0.77 0.000***
Molar relation 2.42 1.18 -2.82 1.18 0.000***
(*) significant, (**) highly significant, (***) very highly significant

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All in mm

Powerscope Derived parameters

Mean change in the upper jaw base -1.48

Mean change in the lower jaw base 4.88
Mean change in the upper molar -1.18
Mean change in the Lower molar 3.72
Overjet reduction -7.14
Mean change in the maxillary incisor position -1.2
Mean change in the mandibular incisor 5.94
Dental changes in the maxillary incisor relation ship 0.28
Dental changes in the mandibular incisor relation ship 1.06
Maxillary molar movement with in maxilla 0.3
Mandibular molars with in mandible 1.16
Molar correction 4.90
skeletal correction in molar and Incisor relation correction due
maxillary base 1.18
skeletal correction in molar an Incisor relation correction due
mandibular base 3.22

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Powerscope Results
 Total No. of Subjects in final analysis n=8
 Male n= 6 Female n= 2
 Average age – Male ( 15.6 + 1.2) : Female ( 16.2 + 1.8)
Years
 Total No. of subjects in Stage 5- Males – 3 ; Females -0
 Total No. of subjects in Stage 6- Males – 3 ; Females -2
 Average time of completion of Treatment- 5.2 months
 The pretreatment and post treatment measurements of
the parameters mentioned were analysed by using
Student’s ‘t’-test.
 The skeletal effects and Dental effects of the changes
are tabulated
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Powerscope

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Powerscope

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Powerscope Discussion
Powerscope is introduced by Dr. Andy Hayes. This study was
conducted to evaluate the efficiency of it in class II div2 patients

A molar correction of 4.90 mm and Incisor overjet reduction of

7.12mm is achieved by Powerscope in class II Div2 patients. This
correction is achieved in an average time of 5.2months

The molar correction is significantly skeletal in nature and major

part of the change in the molar relation is due to lower skeletal
growth

Powerscope has more Skeletal effects in class II div2 patients and this is
contrast to previous study of Vinni Aroraa et al ( 2018) in class II Div 1
patients. Their study showed a forward movement of the mandibular
molar and incisors by the PowerScope patients (2.3 mm and 2.80 mm).
Dentoalveolar changes are more with Powerscope.
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Powerscope

• The Results of the study are in concordance with the

study of Antony et al (2018). Total treatment
duration was 5.5 months, with a molar correction of
4.04 mm achieved at a rate of 0.73 mm/month in
their study

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Powerscope Limitations
• This is basically an observational study

• The change in inclination of the Maxillary

incisors in not uniform for all the patients

• Comparative studies with other appliances

have to be conducted

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Powerscope
Conclusion

Powerscope is a powerful propeller of skeletal mandibular

growth in class II div2 patients with decelerating growth
phase

Skeletal changes are more more visible than the dento

alveolar changes

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