Management of Skeletal Class II Malocclusion in Non-Complaint Patient using Powerscope-A Case Report

Class II malocclusion in pubertal phase presents a major and a common challenge to orthodontists. Proper diagnosis and treatment planning in early stage help in preventing and intercepting the severity of malocclusion. In pubertal phase skeletal Class II malocclusion due to mandibular retrusion are best treated with functional appliance. In recent time PowerScope fixed functional appliance is gaining immense popularity as noncompliant Class II corrector. In the present case report an adolescent male patient having Class II division 1 malocclusion with functional jaw retrusion was treated using MBT 0.022” prescription and PowerScope appliance. 7-8 months of PowerScope wear obtained stable and successful results with improvement in facial profile, skeletal jaw relationship and mild increase in IMPA. It can thus be concluded that PowerScope gives good results in Class II correction with a combination of patient comfort and ease of use that was unmatched among other appliances.


INTRODUCTION
In recent time, due to slight increase in awareness, there is increase in number of patients seeking orthodontic treatment. Among all types of malocclusion, patient with Class II malocclusion are more concerned about their facial esthetic since early age only. 1 Class II treatment depends upon its nature i.e. dental or skeletal, severity, and age of the patient. 2 In the pubertal growth phase skeletal Class II malocclusion is treated with orthopedic or functional appliances.
Skeletal Class II malocclusion with retrognathic mandible is corrected using functional appliance to redirect mandibular growth by forward posturing of the mandible. During the period of active growth, various myofunctional appliances like the Activator, Bionator, Frankel's regulator and the Twin block are being used. 3,4 Fixed functional appliances like Jasper-Jumper, Herbst, Ritto appliance, Eureka spring, Churrojumper, PowerScope, etc. would be the better choice, if the patient reports after the pubertal growth spurt or during the late stages of puberty, and it also reduces the need of patient compliance. The later has recently been gaining immense popularity as fixed functional appliance. These appliances are installed to the maxillary and mandibular archwires.
PowerScope is delivered as one-size-fits-all appliance, which is pre-assembled with attachment nuts for quick and easy chair side application. The appliance is a wire to wire installation with attachments placed mesial to  Table 1]. Dento-alveolar readings suggested proclined maxillary anterior teeth with mildly retroclined and retruded mandibular anteriors. The mandibular plane angle was less than normal, suggesting horizontal growth pattern. Skeletal age of the patient was determined by using CVMI & MP3 methods, which

Treatment progress
Maxillary and mandibular arches were bonded with 0.022" slot MBT pre-adjusted appliance. 0.014" NiTi was placed in maxillary arch, while in mandibular arch proximal stripping was carried out & 0.014" NiTi was placed and lateral incisor was engaged in second visit, which was followed by 0.018" stainless steel wire with curve of spee, 0.017 × 0.025" and 0.019 × 0.025" NiTi.
Finally, after alignment of 2nd molars 0.019" × 0.025" stainless steel wires were placed with labial root torque in anterior segment of lower arch in order to prevent the flaring of lower anteriors due to PowerScope.
Leveling and alignment was completed in 10 months.
At the end of stage I, overjet was 8 mm and overbite was 4 mm. At this stage PowerScope was installed.
It was attached in maxillary arch mesial to the first molar with attachment nut using the driver provided, while in mandibular arch it was tightened distal to the canine with attachment nuts using driver [ Figure 4].    Table 1].
One undesirable effect with all fixed functional appliances is protrusion of the lower anteriors as the force is concentrated on the lower anterior segment.
However, this was taken care, by using a pre-torqued wire in MBT system with built-in labial root torque of -6 o in mandibular incisor's brackets. 10 The lower archwire was securely cinched distal to lower second molars.
This helped to counteract the protrusive effect of  Table 1].
The results achieved were stable and highly satisfying for both the clinician as well as the patient.