Combination of activator and extraoral forces: Case presentation and literature review.

The aim of this paper is the presentation of the treatment of a patient, where a combination of an activator with high pull extraoral forces was applied, followed by fixed orthodontic appliances. In addition a review of the literature concerning this subject will be introduced. The patient presented skeletal Class II relations with a hyperdivergent facial type, a clockwise rotation of the mandible and Class II, division 1 dental relationships. He was treated in two phases. The first phase included the combined application of an activator and high pull extraoral forces, while during the second phase fixed appliances were placed, as well. The dental anomaly was corrected completely, while the skeletal relations, the relations of the lips and the facial profile were improved.