title: Combined treatment with headgear and the Frog appliance for maxillary molar distalization: a randomized controlled trial.
abstract: OBJECTIVE
  To evaluate the efficiency of the Frog appliance (FA) alone or in combination with headgear for distalizing the maxillary molars.
  
  
  METHODS
  Fifty patients (25 males and 25 females) aged 12.6 - 16.7 years who received treatment for Class II malocclusion at the Orthodontic Clinic of Al-Baath University were selected for this study and randomly divided into 2 equal groups. Maxillary molar distalization was achieved using the FA alone (group 1) or a combination of the FA with high-pull headgear worn at night (group 2). Lateral cephalograms were obtained before and after treatment.
  
  
  RESULTS
  The maxillary molars moved distally by 5.51 and 5.93 mm in groups 1 and 2, respectively. Distal movements were associated with axial tipping by 4.96° and 1.25°, and with loss of anchorage by mesial movement of the second maxillary premolars by 2.70 and 0.90 mm in groups 1 and 2, respectively. The combined use of the FA and nighttime high-pull headgear decreased the distalization time and improved the ratio of maxillary molar distalization movement relative to the overall opening space between the first maxillary molars and second premolars.
  
  
  CONCLUSIONS
  The FA can effectively distalize the maxillary molars, this distalization associates with some unfavorable changes. Nighttime use of high-pull headgear combined with the FA can reduce these unfavorable changes and improve treatment outcomes.
authors.affiliation: Department of Orthodontics, Faculty of Dentistry, Al-Baath University, Homs, Syria.
authors.forename: Ahmad Sharafeddin
authors.initials: AS
authors.lastname: Burhan
keywords: Headgear; Malocclusion; Molar distalization; Orthodontic appliances