Tricks of the Trade: Managing a debonded bracket during fixed Class II correction

The use of fixed Class II correctors is gaining in popularity as the appliances become more robust and easier to use. However, breakages can still be a problem. A simple and elegant solution is presented to deal with a debonded bracket that otherwise would result in cessation of the Class II correction and extension of treatment time.

Although most of their effects are dento-alveolar, use of fixed correctors has been shown to be a reliable and predictable way of treating Class II malocclusions.^1,2 However, one of the main problems with any fixed Class II corrector or functional appliance is the high level of breakages reported, and the time and cost that this incurs.³ As most of the more contemporary appliances, such as the FORSUS (3M Unitek Corp, Monrovia, CA, USA) and PowerScope (American Orthodontics, Sheboygan, WI, USA), are attached directly to the archwire of labial fixed appliances, one of the commonest breakages encountered is debonding of the bracket of either the lower canine or first premolar, dependent on where the piston or spring of the appliance is engaged in the lower arch. This will result in deactivation of the appliance and, unless spotted early by the patient, disengagement and displacement of the detached tooth from the archwire. As these type of appliances require the use of reactangular steel wires to prevent any archwire distortion, and to limit unwanted tooth movement, it would then usually mean removing the Class II corrector and working archwires, rebonding the bracket and realigning the tooth in lighter wire, before working back up in the rectangular stainless steel wire and recommencing the Class II correction, adding months to what can already be a protracted treatment.