Indications for Use:

Increasing anchorage in the upper arch by adding tooth units is a very effective way to maintain the gain. Typically, the upper bicuspids have a tendency to come forward slightly (about 1/3 of the movement) while the upper molars move distally. This is particularly true when the upper deciduous cuspids have been lost and the permanent cupids are either unerupted or blocked out of the arch. This is very common due to the timing of Pendulum therapy and the tendency for blocked cuspids in Class II malocclusions. The bicuspids can very easily come forward, further impacting the unerupted cuspids. It is very important that the cuspid eruption site either be maintained or increased during the Pendulum phase of therapy.

Figure 19. Anterior view of early bonding of the upper arch while the Pendex Appliance is still active. The archwire is sectioned at the midline to allow for expansion. The sections terminate in the bicuspid areas. No attempt is made to align the upper incisors until expansion is completed; then a continuous archwire can be placed.

Figure 20. Occlusal view of sectional leveling arches with Pendex in place. Note push coil in upper left cuspid region. This technique pits the entire upper arch against the upper molars to bolster anchorage and prevent undue forward movement of the buccal teeth.

Technique:

The upper arch is bonded at the same time that the Pendulum Appliance is placed. A push coil is added between the lateral incisors and first bicuspids and a sectional leveling wire (.016 Ni-Ti) is placed to the midline. These left and right sectional wires are stopped at the midline so that the mid-palatal jackscrew can be activated and upper arch expansion can occur. Using a continuous arch prevents the maxillae from separating at the midline.

Considerations:

In severe Cl II, D 1 malocclusions with a large overjet where the upper incisors are already flared, early bonding can further exacerbate the incisor proclination. Early bonding is ideal in the Cl II, D 2 malocclusion, however, as the reciprocal forward movement of the incisors clears the lower arch for future bonding, improves incisor torque, opens space for erupting cuspids, frees the mandible from distal displacement and greatly enhances upper molar movement. All of these are quite desirable responses in the Cl II, D 2 brachyfacial malocclusion, where midfacial orthopedics can create maxillary deficiency with negative esthetic consequences.