OPMag DischingerBy Terry G. Dischinger, DDS

A Herbst appliance is widely used in today’s orthodontic treatment to resolve Class II malocclusions, yet they can interfere with fixed appliance treatment since they must be attached to the mandibular first premolars or have a long cantilever arm that prohibits bracket bonding.

Market research indicates that more than 50% of orthodontic patients are classified as Class II cases. Yet, the traditional Herbst treatment is unable to correct the A-P relationship of the upper and lower jaw while simultaneously addressing orthodontic issues—which results in extended treatment times in order to first achieve the skeletal correction.

The AdvanSync 2 Molar to Molar Class II Corrector has allowed us to orthopedically correct the Class II while simultaneously doing all the orthodontics with the braces, saving 6 to 9 months of treatment time.

Clinical Treatment Tips

When using AdvanSync 2, use brackets and archwires to control incisor torque and maxillary and mandibular molars. Once the crowns are cemented, we figure-eight-lace the maxillary full arch 6-6. This is key to the treatment. This prevents distalization of the upper molars and promotes maximum orthopedic effect. To advance the mandible, reactivate AdvanSync every 2 to 3 months by 4 mm.

CP Dischinger225For optimal results, use a custom-fabricated AdvanSync appliance on mixed dentition cases in combination with the same treatment protocol used with permanent dentition cases. Our research shows that mixed dentition cases achieve long-term stability and possible long-term change in the growth direction of the mandible.

If a tomogram or iCat is available, take joint films before AdvanSync removal to confirm condylar position. If a tomogram or an iCat is not available, maintain the final overcorrected position for 4 ½ months.

When the AdvanSync 2 is removed, minimal orthodontics will be required to finish the case. This allows Class II treatment in Class I time without regard to patient cooperation and with great patient comfort.