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| CASE REPORT |
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| Year : 2018 | Volume
: 9
| Issue : 2 | Page : 96-99 |
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Class II division 1 malocclusion treated by a modified fixed functional appliance in an adolescent boy
Vivek Agarwal1, Debapratim Jana1, Sathesh Kumar Sivalingam2, Shirish Goel3
1 Department of Orthodontics & Dentofacial Orthopaedics, Haldia Institute of Dental Sciences & Research, Balughata, Haldia, India
2 Department of Orthodontics & Dentofacial Orthopaedics, JKK Nataraja Dental College, Komarapalayam, Tamil Nadu, India
3 Department of Orthodontics & Dentofacial Orthopaedics, Maitri College of Dentistry & Research, Anjora, Chattisgarh, India
| Date of Web Publication | 18-Jun-2018 |
Correspondence Address:
Vivek Agarwal
Flat No. 3B, Block III, Sreeram Nagar, Teghoria, VIP Road, Kolkata - 700 052, West Bengal
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/srmjrds.srmjrds_18_18
Treating a Class II patient has always been a challenge to orthodontist, especially in noncompliant adolescents. An appliance that minimizes the dependence on patient cooperation, reduces the treatment duration, and is esthetically less visible offers a potential solution to some compliance problems encountered in orthodontic practice. This article presents a case report of a 13-year-old male with a Class II division 1 malocclusion treated with a modified Churro jumper, by inserting it on an auxiliary wire (consisting of a molar segment, a posterior vertical segment, a vestibular segment, and an anterior vertical segment) placed on the mandibular arch, instead of directly placing on the main arch wire, to improve its efficiency. The patient responded well to the fixed functional appliance and saved the treatment time spent in aligning the bicuspids later. Keywords: Churro jumper, Class II, fixed functional appliance
How to cite this article:
Agarwal V, Jana D, Sivalingam SK, Goel S. Class II division 1 malocclusion treated by a modified fixed functional appliance in an adolescent boy. SRM J Res Dent Sci 2018;9:96-9 |
How to cite this URL:
Agarwal V, Jana D, Sivalingam SK, Goel S. Class II division 1 malocclusion treated by a modified fixed functional appliance in an adolescent boy. SRM J Res Dent Sci [serial online] 2018 [cited 2023 May 28];9:96-9. Available from: https://www.srmjrds.in/text.asp?2018/9/2/96/234588 |
| Introduction | |  |
Lack of compliance in the adolescent population is a major concern of health-care providers. Orthodontic treatment in patients with limited compliance can result in a longer treatment time, destruction of the teeth and periodontium, extraction of additional teeth, frustration for the patient, and additional stress for the orthodontist and staff.[1] In the recent past, a lot of appliances have been introduced to correct Class II malocclusion for a noncompliant patient. These appliances can also be used in compliant patients with almost completed prepubertal growth, at an early phase of permanent dentition and when the maxillary second molars have already erupted. Appliances such as Jasper jumper,[2] SAIF springs,[3] Herbst appliance,[4] mandibular protraction appliance,[5] adjustable bite corrector,[6] Forsus fatigue-resistant device,[7] Eureka spring,[8] Churro jumper,[9] and mandibular anterior repositioning appliance [10] are a few to mention.
A Churro jumper, when used as a Class II corrector, can be used unilaterally or bilaterally and is cost effective. A Class II patient treated with Churro jumper has at least the first premolar brackets omitted to provide space for it to slide on the mandibular arch wire.[9] However, this could result in loss of alignment of the bicuspids and subsequent increase in the treatment duration for stepping down the archwire for picking up the premolar. To eliminate such a potential complication, an auxiliary wire was designed which (similar to the utility arch) was placed in the mandibular arch, and secured onto the main archwire distal to the cuspids, thereby facilitating the free slide of the bite jumper. Being placed lower down in the arch, it further reduces the visibility of the appliance.
This article reports the case of a 13-year-old male with a Class II division 1 malocclusion treated with modified Churro jumper to facilitate reduction in the treatment duration.
| Diagnosis and Treatment Planning | | |
A 13-year-old male presented with a chief complaint of proclined upper incisors and crowding in the lower front region with esthetic concern regarding the facial appearance. Clinical examination revealed a Class II division 1 malocclusion with mild mandibular crowding. His overjet measured 9 mm, and his overbite was 60%. Cephalometric analysis revealed a brachyfacial growth pattern and a retrognathic mandible [Figure 1]a,[Figure 1]b,[Figure 1]c,[Figure 1]d,[Figure 1]e,[Figure 1]f,[Figure 1]g,[Figure 1]h,[Figure 1]i,[Figure 1]j. Extraoral examination showed a convex profile with potentially competent lips. The full complement of teeth was present with a satisfactory oral hygiene and an exaggerated curve of Spee. | Figure 1: (a-j) Pretreatment extraoral and intraoral photographs along with the radiographs
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The following treatment plan was established: (1) leveling and alignment of the arches using preadjusted edgewise appliance, (2) gain space for decrowding the lower anteriors by proximal stripping and archwire expansion, (3) correction of the Class II skeletal base by functional advancement of the mandible using a modified Churro jumper, and (4) final finishing and detailing of the occlusion.
| Treatment Progress | | |
A preadjusted edgewise appliance (0.022” slot) was placed. Following the strap up of both the arches [Figure 2]a,[Figure 2]b,[Figure 2]c, the sequence of leveling and aligning archwires was as follows: 0.014” nickel titanium and 0.016” nickel titanium. The leveling and alignment was completed with 0.017” × 0.025” nickel–titanium wire in 7 months and subsequently heavier wires were engaged in the brackets. Prefunctional orthodontics took about 13 months.
At the subsequent appointment, 0.021” × 0.025” stainless steel wire was placed in the bracket slot. The length of the jumper was determined as advocated by Castañon et al.[9] and was found to be 34 mm. The Churro jumper was fabricated in 0.028” wire and polyvinyl impression material was filled in the lumen of the jumper. A push force is generated with the appliance and, thus, generates an intrusive force on the maxillary molars and mandibular incisors and thereby the downward and backward mandibular rotation is lessened.
Experience while treating previous patients showed loss of time due to inclusion of premolars later in the treatment. There was also increased incidence of canine brackets debonding with the original appliance design. Thus, a modified approach was used in our setting to improve the efficiency of the appliance. An auxiliary wire of dimension 0.019” × 0.025” stainless steel was placed in the mandibular arch. It consisted of (a) molar segment inserted into the mandibular auxiliary slot, (b) a posterior vertical segment which is formed (length as determined by the vestibular depth) by making a 90° bend gingivally, (c) a vestibular segment which bypasses the premolar brackets, and (d) an anterior vertical segment which hooks onto the main archwire distal to the canine bracket [Figure 3]. | Figure 3: The modified appliance with an auxiliary wire placed in the molar tube
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The auxiliary arch was fabricated such that it was midway in the vestibular area. This care was taken to prevent the loss of appliance activation and soft-tissue irritation if placed deeper in the vestibule. The jumper's maxillary circle was attached onto the maxillary headgear tube and the mandibular circle was attached onto the auxiliary wire placed [Figure 4]a,[Figure 4]b,[Figure 4]c. This reduced the chances of canine bracket debonding as was seen in the patients previously treated in our setting. The buccal bow present in the jumper generates the desired force as it attempts to straighten itself. The patient readily adapted to the appliance. Being placed lower down in the arch, the visibility of the appliance was reduced.
Seven months postinsertion of the jumper, a full cusp Class I molar relation was achieved, following which the Churro was removed. 0.014” stainless steel wires were then placed in the upper and lower arches and bilateral triangular elastics were placed for achieving final interdigitation. The occlusion improved after 3 weeks of wearing the up-and-down elastics. With the stable occlusion achieved, the appliance was removed and the retainers were placed. [Figure 5]a,[Figure 5]b,[Figure 5]c,[Figure 5]d,[Figure 5]e,[Figure 5]f,[Figure 5]g,[Figure 5]h,[Figure 5]i,[Figure 5]j shows the posttreatment extraoral and intraoral photographs and the radiographs. | Figure 5: (a-j) Posttreatment extraoral and intraoral photographs along with the radiographs
Click here to view |
| Conclusion | | |
With a minor alteration in the appliance, by the introduction of an auxiliary wire in the mandibular arch, the Churro jumper could be used more efficiently, eliminating the problems previously encountered. The appliance can well be used in conjunction with fully bonded arch and, thus, saves the treatment time spent in aligning the bicuspids later.
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
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| 3. | Starnes LO. Comprehensive phase I treatment in the middle mixed dentition. J Clin Orthod 1998;32:98-110. [ PUBMED] |
| 4. | Pancherz H. Treatment of class II malocclusions by jumping the bite with the herbst appliance. A cephalometric investigation. Am J Orthod 1979;76:423-42. [ PUBMED] |
| 5. | Coelho Filho CM. Mandibular protraction appliances for class II treatment. J Clin Orthod 1995;29:319-36. [ PUBMED] |
| 6. | West RP. The adjustable bite corrector. J Clin Orthod 1995;29:650-7. [ PUBMED] |
| 7. | Vogt W. The forsus fatigue resistant device. J Clin Orthod 2006;40:368-77. [ PUBMED] |
| 8. | DeVincenzo J. The Eureka spring: A new interarch force delivery system. J Clin Orthod 1997;31:454-67. [ PUBMED] |
| 9. | Castañon R, Valdes MS, White LW. Clinical use of the Churro jumper. J Clin Orthod 1998;32:731-45. |
| 10. | Eckhart JE. Introducing the MARA. Clin Impressions 1998;7:2-5, 24-7. |
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]
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