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JIOS
10.5005/jp-journals-10021-1319
Sharma’s Bite Corrector Appliance
CLINICAL INNOVATION
Sharma’s Bite Corrector Appliance
1
Narendra Shriram Sharma, 2Preethi Sharma, 3Sunita Shrivastav, 4Ranjit Kamble, 5Krishna Sharma
ABSTRACT
Fixed functional appliances (FFAs) have gained the popularity
for growth modification in noncompliant patients, especially
hybrid types. But for this, clinicians have to depend on certain
commercially available appliances; otherwise components
required in fabrication of hybrid type appliances are not routinely
available in clinics, which discourage their use. Additionally,
these preformed appliances have less scope in changing their
length as per patient’s requirement of particular mandibular
advancement. This article explains the chairside fabrication
of hybrid type FFA named ‘Sharma’s bite corrector appliance’
(SBCA). This custom-made and hygienic design provides stable
fixation, less breakages with increased range of mandibular
movement involving unrestricted mouth opening. SBCA permits
quick chairside fabrication with ease in installation of appliance
and is inexpensive.
Keywords: Fixed functional appliance, Class II correction,
Mandibular advancement, Growth modification, Fatigue
resistant device, SBCA.
How to cite this article: Sharma NS, Sharma P, Shrivastav S,
Kamble R, Sharma K. Sharma’s Bite Corrector Appliance.
J Ind Orthod Soc 2014;48(4):573-577.
Source of support: Nil
Conflict of interest: None
Received on: 19/3/14
Accepted after revision: 4/6/14
INTRODUCTION
Fixed functional appliances (FFAs) are popular for growth
modification.1,2 Rigid, flexible and hybrid appliances have
been introduced, including Herbst, Jasper Jumper, Eureka
Spring, Forsus, Klapper super spring II, Twin Force Bite
Corrector, Mandibular Protraction Appliance, etc.3-9 Noncompliant patients require the fixed functional approach.
1
Associate Professor, 2Resident (2nd Year)
Professor and Head, 5Senior Resident
3,4
1,3-5
Department of Orthodontics, Sharad Pawar Dental College
Wardha, Maharashtra, India
2
Department of Oral Pathology, Sharad Pawar Dental College
Wardha, Maharashtra, India
Corresponding Author: Narendra Shriram Sharma, Associate
Professor, Department of Orthodontics, Sharad Pawar Dental
College, Wardha, Maharashtra, India, Phone: 9326390639
e-mail: [email protected]
Small and hygienic design, stable fixation, less breakages,
wide range of mandibular movement with mouth opening
made the hybrid FFAs popular. Forsus type superelastic
spring-loaded appliances have gained popularity because
of their ease in clinical application and expedient design.
When considering chairside fabrication, many of the times
routinely components are not available for the clinician in
practice, which discourage its use. Compliance with use
of preadjusted edgewise appliance is also essential, e.g.
push rod in Forsus is easy going in placement and removal.
For this, with an exception many times clinician has to
be dependent on prefabricated design by manufacturers.
Chairside quick fabrication of spring loaded FFA from
usually available clinical wire components is described here.
Appliance Construction
Total length of the appliance is decided by measuring the
distance from distal of maxillary headgear tube to the distal
of the mandibular canine in desirable advanced mandibular
position. Following things are necessary for the fabrication
of the appliance:
• 1 mm thick-round TMA wire 10 cm in length (Fig. 1A),
wire cutter and E4 Player (Fig. 1A)
• 0.8 mm (0.032") thick hard-round stainless steel wire
• Solder, flux and heat source, e.g. soldering torch.
1. Maxillary tube assembly: Take 10 cm long TMA wire and
make a loop on one free end to approximate it through
maxillary molar tube (headgear tube) (Fig. 1B). Give
90° bend from end of loop (Fig. 1C). Make a coil of
3 mm diameter, 8 mm from the bend in same direction
(Fig. 1D). Again make another coil of 3 mm diameter,
from the bend in opposite direction (Fig. 1E). Then
prepare a small circular loop 10 mm in front of second
coil in same direction for engaging distal to canine
(Fig. 1F).
2. ‘Ball-end L-hook’: It is prepared in 0.8 mm thick wire
by putting a round drop of solder at one end; this is
used to secure the maxillary end assembly in place with
insertion of ‘Ball-end L-hook’ from distal of maxillary
tube (Fig. 1G) and cinching mesially.
Installation of Appliance
Make sure that consolidated upper and lower arches have
reached a stage of full slot engagement of stainless steel
archwires in either 0.018" slot or 0.022" slot (Figs 2A to F).
The Journal of Indian Orthodontic Society, October-December 2014;48(4):573-577
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Narendra Shriram Sharma et al
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B
C
D
E
F
G
Figs 1A to G: Steps in preparation of maxillary tube assembly
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Sharma’s Bite Corrector Appliance
A
B
C
D
E
F
Figs 2A to F: Pretreatment photographs of the patient
Transverse stabilization of upper molars should be done
with transpalatal arch to avoid upper arch expansion,
which happens due to the FFAs. Wires are secured with
stainless steel ties rather than e-modules. Additional lower
incisor labial root torque (e.g. MBT, Alexander prescription
preferred) and cinch it behind the lower molar tube.
Maxillary end assembly is secured by inserting Ball-end
L-hook through maxillary molar tube (headgear tube). Wire
coming mesially from opening of headgear tube is cinched
upward, where free end tucked inside molar hooks. Molar
bands with headgear tube positioned occlusally are preferred
for installation of SBCA. Mandibular push component is
inserted through anterior opening of a small circular loop
distal to canine (for engaging fetching hook). Length of the
mandibular push component should be kept such that, it
should not poke out when the jaw is closed. Fetching hook
engagement is carried out by either asking the patient to
protrude the mandible or by compressing the mandibular
push components. Once the fetching hook is engaged on
both sides, asking the patient for gradual mouth opening,
check the possibility of dislodgement of the push component
from the wire. Mandibular advancement, patient comfort and
midlines should be confirmed then final crimping is done with
a Weingart plier. This completes the engagement and crimping
of fetching hook inside the circular loop of the archwire distal
to the mandibular canine. Same procedure is followed for the
installation of appliance on the contra lateral side (Figs 3A to G).
Then explain the postappliance placement instructions and
prescribe a mouthwash. The patient recalls for every month
check-up. After correction of overjet appliance was removed
and settling of occlusion was done (Figs 4A to F).
ADVANTAGES
This customized design provides more scope for chairside
alteration in the dimensions of the appliance as per patient
requirement unlike the other commercially available devices.
The results are similar to those of other commercially
available designs used for Class II correction, with the
following advantages:
• Appliance length can be changed chairside easily for
increase or decrease in mandibular advancement and as
per clinician’s requirement.
• Alterable in force levels (number of turns of coils
doubled with in same length).
The Journal of Indian Orthodontic Society, October-December 2014;48(4):573-577
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Narendra Shriram Sharma et al
A
B
C
D
E
F
G
Figs 3A to G: Appliance installed for Class II correction of a patient. Lateral movements permitted and maximum limit of mouth
opening of patient possible without dislodging of mandibular push component from maxillary tube assembly
•
•
•
•
Permits wide range of mandibular movement with
unrestricted mouth opening.
Quick, easy chairside fabrication and installation.
Stable fixation.
Increased flexibility in the appliance reduces breakages
and extra appointments.
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•
•
•
It has versatility to be used with preadjusted edgewise
appliances for Class II, III and subdivision correction.
Small and hygienic design, easy to place and remove
from mandibular archwire.
SBCA is simple and inexpensive.
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Sharma’s Bite Corrector Appliance
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Figs 4A to F: Post-treatment photographs of the patient
REFERENCES
1. McSherry PF, Bradley H. Class II correction-reducing patient
compliance: a review of the available techniques. J Orthod
2000;27(3):219-225.
2. Bilgiç F, Hamamci O, Baseman G. Comparison of the effects of
fixed and removable functional appliances on the skeletal and
dentoalveolar structures. Aust Orthod J 2011;27(2):110-116.
3. Devincenzo J. The Eureka spring: a new interarch force delivery
system. J Clin Orthod 1997;31(7):454-467.
4. Coelho Filho CM. The mandibular protraction appliance No. 3.
J Clin Orthod 1998;32(6):379-384.
5. Klapper L. The super spring II: a new appliance for noncompliant Class II patients. J Clin Orthod 1999;33(1):
50-54.
6. Bowman SJ. Class II combination therapy (distal jet and
Jasper Jumpers): a case report. J Orthod 2000;27(3):213218.
7. Coelho Filho CM. The mandibular protraction appliance no. 4.
J Clin Orthod 2001;35:18-24.
8. Rogers MB. Herbst appliance variations. J Clin Orthod
2003;37(3):156-159.
9. Sood S. The forsus fatigue resistant device as a fixed functional
appliance. J Clin Orthod 2011;45(8):463-466.
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