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Skeletal Class II Malocclusion Treated with AdvanSync 2 - A Case Report

Namrata Dogra1, Archana Jaglan2, M. S. Sidhu3, Seema Grover4, Suman5

1, 2, 3, 4, 5 Department of Orthodontics, SGT University, Gurugram, Haryana, India

INTRODUCTION

Treatment of complex malocclusion poses a challenge for the orthodontist because of Corresponding Author:
its multifactorial aetiology. Class II malocclusion is the most frequently encountered Dr. Namrata Dogra,
and treated malocclusion in orthodontic practice and affects approximately 14.6 % Department of Orthodontics,
SGT University, Gurugram,
of the North Indian population.1 A common reason for Class II malocclusion is
Haryana – 122505, India.
mandibular skeletal retrusion which is the most common characteristic, as reported E-mail: [email protected]
by McNamara.2 This can be caused by genetic or hereditary factors. When evaluating
treatment options for Class II patients, the extent of the skeletal discrepancy and the DOI: 10.14260/jemds/2021/603
skeletal maturity of the patient needs to be considered. Treatment may range from
dental compensation including camouflage with extractions to surgical procedures How to Cite This Article:
Dogra N, Jaglan A, Sidhu M. S., et al. Skeletal
targeted at moving the jaw at fault. In growing patients, growth modification with
class II malocclusion treated with
functional appliances offers an intermediate treatment option. AdvanSync 2 - a case report. J Evolution Med
Functional appliances are basically of two types; Removable and Fixed. Dent Sci 2021;10(34):2951-2953, DOI:
Removable functional appliances such as Activator, Bionator, Frankel Function 10.14260/jemds/2021/603
regulator and Twin Block appliance change Class II relationship by the transmission
of soft tissue tension to the dentition. Treatment success with these appliances relies Submission 15-04-2021,
Peer Review 18-06-2021,
heavily on patient compliance. Therefore, in non-compliant patients, fixed Class II Acceptance 26-06-2021,
correctors in conjunction with fixed orthodontic appliances are the best choice.3 Published 23-08-2021.
Fixed functional appliances generate continuous stimuli for mandibular growth
without break and permit better adaptation to functions like mastication, swallowing, Copyright © 2021 Namrata Dogra et al.
speech and respiration.1 This is an open access article distributed
under Creative Commons Attribution
The Herbst fixed functional appliance has been used routinely for Class II patients
License [Attribution 4.0 International (CC
and has undergone many design variations over time.4 The AdvanSync2 Class II BY 4.0)]
corrector is a recently introduced fixed functional appliance. It has a much smaller
size than the conventional Herbst appliances, is easier to place, activate and remove
and most importantly, can be used in conjunction with full-arch fixed appliances
throughout.3 Here we describe a case report of a patient treated with the AdvanSync2
Class II corrector and the findings observed in the sagittal and vertical dimensions.

P R E SE N T A T I O N O F C A S E

A 14-year-old male patient reported to the Department of Orthodontics with the

complaint of irregularly placed teeth and poor facial appearance. The patient did not
have any relevant medical history. On extraoral examination, he had a convex profile,
obtuse nasolabial angle, deep mentolabial sulcus and potentially competent lips
(Figure 1). Mandible was severely retrognathic with SNB reduced to 72°. ANB of 5°
suggested Class II skeletal malocclusion and FMA of 25° suggested average growth
pattern. Intraorally, Class II malocclusion with mild to moderate crowding was seen
in the maxillary anterior with buccally erupted canines.
Rotation was present in the upper first premolar of the left and right sides (Figure
2). Increased overjet of 7 mm, and bilateral Class II molar and canine relationship
were found. The patient had a positive visual treatment objective (VTO).

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Jemds.com Case Report
dental relations at the end of the treatment. (Figure 4, Figure
5). Since a majority of tooth movement was completed along
with the functional phase, treatment duration also was
significantly shortened. The remainder of treatment took an
additional 6 months with the patient presented in retention
with an upper removable wraparound retainer and a lower
canine to a canine lingual bonded retainer. The total treatment
time was 17 months.
Figure 1a, b & c. 1a. Pre-Treatment Extraoral Frontal Photograph; 1b.
Pre-Treatment Extraoral Photograph Showing Anterior Teeth; 1c. Pre
- Treatment Extraoral Profile Photograph

Figure 3a, b, c, d & e. 3a. Mandibular Advancement with AdvanSync2

3a. Intraoral Right Lateral Photograph; 3b. Intraoral Frontal
Photograph; 3c. Intraoral Left Lateral Photograph. 3d. Occlusal
Maxillary Photograph; 3e. Occlusal Mandibular Photograph
Figure 2a, b, c, d & e. 2a. Pre-Treatment Intraoral Right Lateral
Photograph; 2b. Pre-Treatment Intraoral Frontal Photograph; 2c. Pre-
Treatment Intraoral Left Lateral Photograph; 2d. Pre-Treatment
Occlusal Maxillary Photograph; 2e. Pre-Treatment Occlusal
Mandibular Photograph

D I SC U S SI O N O F M A N A G E M E N T

Treatment Objectives
1. To improve maxillomandibular Class II skeletal and
Figure 4a, b & c. 4a. Post-Treatment Extraoral Frontal
dental relationship Photograph; 4b. Post-Treatment Extraoral Photograph Showing
2. To achieve ideal levelling and alignment of arches Anterior Teeth; 4c. Post-Treatment Extraoral Profile
3. To establish ideal overjet and overbite

Treatment Progress
The treatment plan was discussed with the patient and
informed consent was obtained. The treatment plan included
a non-extraction treatment with initial levelling and alignment
of arches followed by the application of a fixed functional
Figure 5a, b & c. 5a. Post-Treatment Intraoral Right Lateral
appliance to correct the dental and skeletal sagittal Photograph; 5b. Post-Treatment Intraoral Frontal Photograph;
discrepancies. Maxillary and mandibular arches were bonded 5c. Post-Treatment Intraoral Left Lateral Photograph
using .022” × .028” pre-adjusted edgewise MBT appliance
prescription. (Di MIM Mini Twin Bracket system, Ortho Variable Pre - Treatment Post - Treatment
SNA 77 degrees 76 degrees
organizers, A Henry Schein Company). The interproximal SNB 72 degrees 74 degrees
reduction was done in the upper anterior and initial levelling ANB 5 degrees 2 degrees
FMA 25 degrees 26 degrees
and alignment were done in both the arches with 0.14 NiTi IMPA 112 degrees 113 degrees
wires in the upper and lower arch followed by 0.016 LAFH 60 mm 66 mm
Skeletal convexity 5mm 2mm
Australian wires and 0.016 x 0.022 S. S wires. An AdvanSync2 Table 1. Pre-Treatment and Post-Treatment Cephalometric Data
Class II corrector (Ormco Corp, Glendora, California) was
delivered in the levelling and alignment stage. The
AdvanSync2 appliance was reactivated by 2 mm thrice during
the therapy. A Class I skeletal and dental relation was achieved D I SC U S SI O N
in 11 months (Figure 3). At the end of the functional phase, the
arch wires were 19 × 25 S. S wires in both the arches. After Class II malocclusion can be treated with different modalities
removal of the appliance, 0.016 x 0.022 S. S wires were placed depending upon the growth status of the patient. A growing
in upper and lower arches and Class II elastics were started. Class II patient can be effectively managed with functional
Post-functional cephalometric analysis revealed an improved appliances.
ANB angle of 2° and FMA of 26°, and reduced skeletal According to Pangrazio et al. removable or fixed functional
convexity (Table 1). There was a dramatic improvement in the appliances bring about sagittal and vertical skeletal changes in
profile of the patient with the achievement of ideal skeletal and

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Jemds.com Case Report
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Financial or other competing interests: None.
Disclosure forms provided by the authors are available with the full
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text of this article at jemds.com. meta-analysis. Eur J Orthod 2016;38(2):129-39.

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