Pacific Coast Society of Orthodontists Bulletin Summer 2020 - 43

Let's Talk About That

only attaching to the molars and not coming as
far forward in the mandibular arch as typical appliances. This leads to a much more comfortable
experience for the patient. In addition, by being
smaller, it allows the clinician to place brackets
on all the teeth from premolar to premolar, with
arch tubes on the crowns of the first molars,
allowing full-arch orthodontics to be performed
while the mandible is being advanced. This leads
to greater efficiency of treatment.
5. How long does active treatment typically take?
It takes from 18 to 22 months.

Figure 2. AdvanSync Class II corrector used by Dr.
Bill Dischinger
use a Herbst-type appliance called the AdvanSync Class II corrector (Figure 2). The appliance
is placed on the first molars in both arches, and
brackets are placed in both arches from second
premolar to second premolar. I will typically
level and align, correcting the vertical overbite
for about four to six months before attaching
the arms to the appliance to start advancing the
mandible. It takes about nine months of active
mandibular advancement to achieve correction.
At that point, I will remove the AdvanSync appliance and place molar tubes and finish treatment
as needed.
4. What are the benefits or advantages of using
your appliance over other approaches to Class
II treatment? First and foremost, the appliance
addresses the true nature of the malocclusion, an
underdeveloped mandible. In these true orthopedic Class II cases, we want to bring the mandible
forward to align with a normally developing maxilla. There are, of course, many modalities that
can do this, but not addressing the mandible does
not solve the true etiology of the malocclusion.
Apart from that, the advantage of the AdvanSync appliance compared to other appliances
that address the mandible is its size. It is much
smaller than traditional orthopedic appliances,

Summer 2020    PCSO Bulletin	

6. What is done at each appointment during
this treatment? Appointment 1: Place AdvanSync
crowns on the upper and lower 6s. Bond brackets
upper and lower 5-5 and lower 7s. Place 0.014-in
CuNiTi wires on upper 6-6, lower 7-7.
Appointment 2: At 8 weeks, place upper and
lower 0.014 × 0.025-in CuNiTi wires.
Appointment 3: At 16 weeks, place upper 0.019 ×
0.025-in NiTi with 20° of labial crown torque
and lower 0.017 × 0.025-in TMA. Attach arms
to AdvanSync crowns and begin mandibular
advancement.
Appointment 4: At 6 months, activate 4 mm
AdvanSync arms.
Appointment 5: At 8 months, activate AdvanSync
arms to final, overcorrected position (end on
Class III canine).
Appointment 6: At 11 months, take temporomandibular joint film to verify that condyles are
centered in the fossa.
Appointment 7: At 11.5 months, remove the
AdvanSync appliance. Section wires upper and
lower 5-5.
Appointment 8: At 12 months, bond molars and
reposition any brackets as needed similar to a
pano and reposition appointment. Place 0.014
× 0.025-in CuNiTi wires 7-7.
Appointment 9: At 14 months, place upper 0.019 ×
0.025-in TMA and lower 0.016 × 0.025-in SS wire.
Appointment 10: At 16 months, place upper 0.019
× 0.025-in SS wire.

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Pacific Coast Society of Orthodontists Bulletin Summer 2020

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