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PEARLS Preventing Delays in Forsus Treatment after Canine Bracket Failure

VOLUME 47 : NUMBER 02 : PAGES (108) 2013




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Forsus treatment is routinely used in our practice, beginning after leveling and alignment and placement of a full-size rectangular stainless steel lower archwire. Because we use a fully compressed Forsus that applies strong forces, we avoid potential side effects in the lower arch either by placing rotation wedges on the canine brackets to act as a cushion1 or by tightly tying in the appliance with ligature wire.

Despite these efforts, a lower canine bracket occasionally debonds or detaches from the archwire, resulting in displacement or unwanted rotation of the canine. The usual reaction would be to discontinue Forsus therapy until the canine has been realigned, which can significantly prolong treatment. We have devised a solution that allows us to resume skeletal correction almost immediately, as shown in a patient who came in for an appointment with a missing elastomeric ligature and a severely displaced canine.

The procedure is as follows:
1. After disengaging the mesial end of the Forsus push rod, affix a crimpable hook to the rigid lower archwire at the location of the canine hook, forming a stable anchor for the push rod (A).
2. Place an .014" flexible round nickel titanium overlay wire, and engage the displaced canine to reestablish alignment.
3. When the canine has reached proper alignment in the arch, remove the nickel titanium wire (B). At this point, if further skeletal correction is needed, precautions should be taken, as described above, to prevent future bracket or ligature failure.

This method avoids the chairtime and possible expense of removing and later reinserting the Forsus appliance. Overall treatment duration may not be significantly affected if Class II therapy can be continued without interruption.
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