A new modified tandem appliance for management of developing Class III malocclusion
This was a case report of an 8-year-old young boy who had a complaint of reverse relation of the front teeth. On extraoral examination, he has mild concave facial profile with midface deficiency, competent lips and no temporomandibular joint disorder or facial asymmetry []. Intra oral examination revealed anterior cross bite and tendency toward Class III malocclusion (as multiple anterior teeth were in cross bite), with a 2 mm reverse overjet and 40% overbite []. No forward functional shift of mandible was noted on closing movement of mandible. Patient was unable to achieve the edge to edge contact on the incisors. The family history was contributory as patient's father has similar malocclusion.\nOn analysis of lateral head cephalogram patient had Class III maxillomandibular relation (ANB = −2°, Wits appraisal = −2 mm). There was horizontal growth tendency with FMA 18°, SM-MP 4°, and Jarabak ratio was 69.5%. Maxilla was deficient and retrognathic with normal mandible. Upper and lower incisors were normally placed in there basal bone [Figures and , ].\nFor early management of the case we planned to use of new modified tandem appliance with keeping objectives in our mind to relieve anterior cross bite as early as possible to provide harmonious jaw growth. Bite registration was done after fabrication of the band on upper and lower second deciduous molars. The upper and lower models were mounted on the articulator with wax bite and then appliance was fabricated in laboratory. After fabrication of appliance; it was properly finished, polished and bands were cemented by glass ionomer luting cement []. Modified face bow was adjusted so that the junction of outer and inner bow should fall at the commissure of lips for easy elastic traction application. An 8 oz, elastic was used for 4 weeks, followed by a 14 oz. Initially, patient was instructed to wear the appliance minimum of 10-12 h/day, including while sleeping. The wear time was gradually increased up to 14-16 h/day. Patient was advised to visit after 1 week to monitor the compliance and check the proper adjustment of appliance and then scheduled to recall at every 4 weeks to monitor the progress.