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References

Cacciatore G, Ghislanzoni LT, Alvetro L Treatment and posttreatment effects induced by the Forsus appliance: a controlled clinical study. Angle Orthod. 2014; 84:1010-1017
Giuntini V, Vangelisti A, Masucci C Treatment effects produced by the twin-block appliance vs the Forsus Fatigue Resistant Device in growing Class II patients. Angle Orthod. 2015; 85:784-749 https://doi.org/10.2319/090514-624.1
O'Brien K, Wright J, Conboy F Effectiveness of treatment for Class II malocclusion with the Herbst or twin-block appliances: a randomized, controlled trial. Am J Orthod Dentofacial Orthop. 2003; 124:128-137 https://doi.org/10.1016/s0889-5406(03)00345-7

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

From Volume 15, Issue 4, October 2022 | Page 214

Article

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.

Therefore, in the instance of the bracket of the lower canine or premolar becoming debonded, to prevent having to suspend the Class II correction and drop back down archwires, the author recommends placing a crimpable hook onto the lower archwire to which the spring of the FORSUS appliance in the case shown, can be engaged (Figure 1). The Class II correction phase of the treatment can then be continued, the bracket rebonded and the tooth realigned, while any residual space is closed and the occlusion settled into Class I. It will take only a few minutes to place the crimpable hook directly to the archwire and will avoid any delays in treatment.

Figure 1. (a) Class II division 2 malocclusion prior to treatment. (b) Labial fixed appliance following initial levelling and alignment with rectangular stainless steel wires and a FORSUS Class II corrector engaged distal to lower canine brackets. (c) Following debonding of the lower left canine bracket, the tooth has moved lingually away from archwire. A crimpable hook has been placed on the archwire to which the spring of the FORSUS appliance is now engaged. (d) At completion of the Class II correction, the lower rectangular has been replaced with a 0.018” stainless steel wire, and space is being recreated for the lower left canine using compressed coil. (e) The lower left canine has now been realigned and final space closure carried out in the upper arch supported by Class II elastics.