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Case Report

Class II division 1 malocclusion treated by a modified fixed

functional appliance in an adolescent boy

Vivek Agarwal, Debapratim Jana, Sathesh Kumar Sivalingam1, Shirish Goel2

Department of Orthodontics & Dentofacial Orthopaedics, Haldia Institute of Dental Sciences & Research, Balughata, Haldia,
1
Department of Orthodontics & Dentofacial Orthopaedics, JKK Nataraja Dental College, Komarapalayam, Tamil Nadu,
2
Department of Orthodontics & Dentofacial Orthopaedics, Maitri College of Dentistry & Research, Anjora, Chattisgarh, India

ABSTRACT
Treating a Class  II patient has always been a challenge to orthodontist, especially in
noncompliant adolescents. An appliance that minimizes the dependence on patient
cooperation, reduces the treatment duration, and is esthetically less visible offers a
potential solution to some compliance problems encountered in orthodontic practice. This
article presents a case report of a 13‑year‑old male with a Class II division 1 malocclusion
treated with a modified Churro jumper, by inserting it on an auxiliary wire (consisting of a
molar segment, a posterior vertical segment, a vestibular segment, and an anterior vertical
segment) placed on the mandibular arch, instead of directly placing on the main arch wire,
to improve its efficiency. The patient responded well to the fixed functional appliance and
saved the treatment time spent in aligning the bicuspids later.

Key words: Churro jumper, Class II, fixed functional appliance

INTRODUCTION of permanent dentition and when the maxillary second

Lack of compliance in the adolescent population is a major
concern of health‑care providers. Orthodontic treatment
in patients with limited compliance can result in a longer
treatment time, destruction of the teeth and periodontium,
extraction of additional teeth, frustration for the patient,
and additional stress for the orthodontist and staff.[1] In
the recent past, a lot of appliances have been introduced to
correct Class II malocclusion for a noncompliant patient.
These appliances can also be used in compliant patients
with almost completed prepubertal growth, at an early phase
Address for correspondence:
Dr. Vivek Agarwal,
Flat No. 3B, Block III, Sreeram Nagar, Teghoria, VIP Road,
Kolkata ‑ 700 052, West Bengal, India.
E‑mail: drvivekagarwal@gmail.com
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molars have already erupted. Appliances such as Jasper
jumper,[2] SAIF springs,[3] Herbst appliance,[4] mandibular
protraction appliance,[5] adjustable bite corrector,[6] Forsus
fatigue‑resistant device,[7] Eureka spring,[8] Churro jumper,[9]
and mandibular anterior repositioning appliance[10] are a few
to mention.
A Churro jumper, when used as a Class II corrector, can be
used unilaterally or bilaterally and is cost effective. A Class II
patient treated with Churro jumper has at least the first
premolar brackets omitted to provide space for it to slide on
the mandibular arch wire.[9] However, this could result in loss
of alignment of the bicuspids and subsequent increase in the
treatment duration for stepping down the archwire for picking
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DOI: How to cite this article: Agarwal V, Jana D, Sivalingam SK, Goel S.
10.4103/srmjrds.srmjrds_18_18 Class II division 1 malocclusion treated by a modified fixed functional
appliance in an adolescent boy. SRM J Res Dent Sci 2018;9:96-9.

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Agarwal, et al.: Class II division 1 malocclusion treated by a modified fixed functional appliance in adolescence

up the premolar. To eliminate such a potential complication,
an auxiliary wire was designed which (similar to the utility
arch) was placed in the mandibular arch, and secured onto
the main archwire distal to the cuspids, thereby facilitating
the free slide of the bite jumper. Being placed lower down
in the arch, it further reduces the visibility of the appliance.
This article reports the case of a 13‑year‑old male with a
Class II division 1 malocclusion treated with modified Churro
jumper to facilitate reduction in the treatment duration.
DIAGNOSIS AND TREATMENT PLANNING
A 13‑year‑old male presented with a chief complaint
of proclined upper incisors and crowding in the lower
front region with esthetic concern regarding the facial
appearance. Clinical examination revealed a Class II division
1 malocclusion with mild mandibular crowding. His overjet
measured 9 mm, and his overbite was 60%. Cephalometric
analysis revealed a brachyfacial growth pattern and a
retrognathic mandible [Figure 1a‑j]. Extraoral examination
showed a convex profile with potentially competent lips. The
full complement of teeth was present with a satisfactory oral
hygiene and an exaggerated curve of Spee.
The following treatment plan was established:  (1)
leveling and alignment of the arches using preadjusted
edgewise appliance,  (2) gain space for decrowding the
lower anteriors by proximal stripping and archwire
expansion, (3) correction of the Class II skeletal base by
functional advancement of the mandible using a modified
Churro jumper, and  (4) final finishing and detailing of
the occlusion.
TREATMENT PROGRESS
A preadjusted edgewise appliance  (0.022” slot)
was placed. Following the strap up of both the
arches [Figure 2a‑c], the sequence of leveling and aligning
archwires was as follows: 0.014” nickel titanium and

a b c

d e f

g h

i j
Figure 1: (a‑j) Pretreatment extraoral and intraoral photographs along with the radiographs

a b c
Figure 2: (a‑c) Leveling and aligning phase

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Agarwal, et al.: Class II division 1 malocclusion treated by a modified fixed functional appliance in adolescence

0.016” nickel titanium. The leveling and alignment was
completed with 0.017” × 0.025” nickel–titanium wire
in 7 months and subsequently heavier wires were engaged
in the brackets. Prefunctional orthodontics took about
13 months.
At the subsequent appointment, 0.021” × 0.025” stainless
steel wire was placed in the bracket slot. The length of the
jumper was determined as advocated by Castañon et al.[9] and
was found to be 34 mm. The Churro jumper was fabricated
in 0.028” wire and polyvinyl impression material was filled
in the lumen of the jumper. A push force is generated with
the appliance and, thus, generates an intrusive force on the
maxillary molars and mandibular incisors and thereby the
downward and backward mandibular rotation is lessened.

Experience while treating previous patients showed loss of

time due to inclusion of premolars later in the treatment.
There was also increased incidence of canine brackets
Figure 3: The modified appliance with an auxiliary wire placed debonding with the original appliance design. Thus, a
in the molar tube modified approach was used in our setting to improve the

a b c
Figure 4: (a‑c) Patient with the Churro jumper placed

a b c

d e f

g h

i j
Figure 5: (a‑j) Posttreatment extraoral and intraoral photographs along with the radiographs

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Agarwal, et al.: Class II division 1 malocclusion treated by a modified fixed functional appliance in adolescence
efficiency of the appliance. An auxiliary wire of dimension
0.019” × 0.025” stainless steel was placed in the mandibular
arch. It consisted of (a) molar segment inserted into the
mandibular auxiliary slot, (b) a posterior vertical segment
which is formed  (length as determined by the vestibular
depth) by making a 90° bend gingivally,  (c) a vestibular
segment which bypasses the premolar brackets, and  (d)
an anterior vertical segment which hooks onto the main
archwire distal to the canine bracket [Figure 3].
The auxiliary arch was fabricated such that it was midway
in the vestibular area. This care was taken to prevent the
loss of appliance activation and soft‑tissue irritation if
placed deeper in the vestibule. The jumper’s maxillary
circle was attached onto the maxillary headgear tube and
the mandibular circle was attached onto the auxiliary wire
placed [Figure 4a‑c]. This reduced the chances of canine
bracket debonding as was seen in the patients previously
treated in our setting. The buccal bow present in the jumper
generates the desired force as it attempts to straighten
itself. The patient readily adapted to the appliance. Being
placed lower down in the arch, the visibility of the appliance
was reduced.
Seven months postinsertion of the jumper, a full cusp Class I
molar relation was achieved, following which the Churro was
removed. 0.014” stainless steel wires were then placed in
the upper and lower arches and bilateral triangular elastics
were placed for achieving final interdigitation. The occlusion
improved after 3 weeks of wearing the up‑and‑down elastics.
With the stable occlusion achieved, the appliance was
removed and the retainers were placed. Figure 5a‑j shows
the posttreatment extraoral and intraoral photographs and
the radiographs.
CONCLUSION
With a minor alteration in the appliance, by the introduction
of an auxiliary wire in the mandibular arch, the Churro
jumper could be used more efficiently, eliminating the
problems previously encountered. The appliance can well
be used in conjunction with fully bonded arch and, thus,
saves the treatment time spent in aligning the bicuspids later.
SRM Journal of Research in Dental Sciences | Volume 9 | Issue 2 | April-June 2018
The authors certify that they have obtained all appropriate
patient consent forms. In the form the patient(s) has/have
given his/her/their consent for his/her/their images and
other clinical information to be reported in the journal. The
patients understand that their names and initials will not
be published and due efforts will be made to conceal their
identity, but anonymity cannot be guaranteed.
Declaration of patient consent
The authors certify that they have obtained all appropriate
patient consent forms. In the form the patient(s) has/have
given his/her/their consent for his/her/their images and
other clinical information to be reported in the journal. The
patients understand that their names and initials will not
be published and due efforts will be made to conceal their
identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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