The Quick Fix device for pseudo-Class III: Resolving anterior crossbites (Part 2)

The Quick Fix* device is based on a typical 2 x 4 edgewise appliance and was designed for effective and efficient advancement of the maxillary incisors.²⁴ The appliance consists of a rectangular stainless-steel arch wire, open coil springs, arch locks and Side Swipe auxiliaries.

Installation of the Quick Fix

Correction of a pseudo-Class III malocclusion in the transitional dentition is initiated by placement of an upper 2 x 4 appliance (e.g., two banded or bonded first molar tubes and pre-adjusted Butterfly Bracket** brackets on the central and lateral incisors).

Leveling and alignment of the incisors using round superelastic wire typically requires two to five months before placing the rectangular wire of the Quick Fix device.

Next, Side Swipe auxiliaries are inserted into the molar tubes and may be tied back (Fig. 5). The Side Swipe will permit an additional arch wire length of 4–5 mm without that extra wire extending distal to the molar tube and poking the buccal mucosa of the cheek.

Universal arch locks are placed about 16–17 mm from the midline mark on the right and left side of a .0175-inch x .025-inch stainless-steel arch (Fig. 6).

This position will permit seating of the arch wire into the incisor brackets with the arch locks distal to the lateral incisors. Sections of open coil spring are slid onto the wire, up to the arch locks. These parts are pre-assembled and stored in anticipation of their future use.

After installation of the Side Swipes, the arch wire of the Quick Fix assembly is inserted into the edgewise tubes of the Side Swipe, not in the molar or headgear tube (Fig. 5). The excess wire now lays adjacent to the molar tube.

The arch wire is then seated into the incisor bracket slots and a stainless-steel ligature is laced, e.g., “figure-8,” (Fig. 5) across to consolidate the incisors together so as to prevent opening space between the teeth. The arch locks are loosened with the wrench, and they are slid distally along the wire to compress the open coil spring (Fig. 7).

Once the locks are positioned between the first and second primary molar, compression is typically sufficient, and the locks are tightened. A distal end cutting pliers are used to cut the arch wire flush to the end of the molar tube, not the Side Swipe tube (Fig. 8).

This will leave about 4–5 mm of wire distal to the Side Swipe next to the molar tube to provide for advancement of the incisors; a process that requires about two to three months.

The Quick Fix device is self-limiting. In other words, should a patient not return within four to five weeks after installation, incisor advancement would only progress until the distal portion of the arch wire slips out of the Side Swipe tube (Fig. 5).

Simple case reports demonstrate the progression of treatment and correction of typical pseudo-Class III anterior crossbites using the Quick Fix device (Figs. 9–13). Other appliances and devices may be combined with the Quick Fix device such as palatal expanders, e.g. MIA Quad Helix,*²⁶ (Fig. 13), reverse pull facemask, lower 2 x 4 and Class III elastics.

After the desired amount of advancement is achieved, then the appliances may be removed and retention initiated as desired.

Class II correction with the Quick Fix device

Molar distalization: Class II elastics

If anchorage is applied to the Quick Fix mechanism to prevent “flaring” of the incisors, then distal movement of the molars can be achieved. Because this device is not inserted into a headgear tube (in contrast to the bimetric arch²²), then a cervical headgear or Jasper Jumper²⁷ fixed functional could be added.

Another alternative would be the application of Class II elastics to support the incisor position. This requires fixed appliances on the lower arch, e.g. 2 x 4 and fixed lingual arch. Unfortunately, both headgear and elastics wear are dependent upon unpredictable patient compliance.

In contrast to the Distal Jet²⁸ (a device specifically designed for molar distalization), both the Quick Fix and bimetric produce force at the crown, rather than through a couple closer to the center of resistance of the molar.

As a consequence, they produce more molar tipping and may introduce unwanted labial tipping of the lower incisors from elastic wear. The use of a pre-adjusted appliance with lingual crown torque in the brackets on the lower incisors may reduce that incisor “flaring.”¹⁸

Molar distalization: mini-screw supported

As an alternative distalization method for Class II patients, mini-screw anchorage can be added to provide indirect anchorage to the Quick Fix. Mini-screws can be inserted into the buccal alveolus, between the upper first molars and second premolars or in the infrazygomatic ridge.^30,32

Stainless-steel ligature is then tied from the mini-screws to the incisors to support the distal-driving force from the Quick Fix.

An alternative miniscrew insertion location would be on the palatal alveolus between the roots of the first molar and second molar^30,31 with a steel ligature tied from the TAD to a button bonded on the lingual of the upper first premolar.

Once the molars have been over-corrected into a super-Class I (half-step Class III) relationship, then the mini-screws may need to be removed, and possibly re-positioned, if they are needed to provide anchorage support for retraction of the remaining maxillary teeth.

Conclusions

Ismail and Bader³² have suggested that, “In developing appropriate treatment plans, dentists should combine the patient’s treatment needs and preferences with the best available scientific evidence, in conjunction with the dentist’s clinical expertise.”

Early correction of pseudo-Class III malocclusion has been demonstrated to provide simple, rapid (about six to eight months), efficient, reliable and stable resolution of anterior crossbite. In addition, this treatment reduces the risk of development of skeletal Class III malocclusions and may diminish the difficulty of, or occasionally eliminate the need for, any later comprehensive treatment.^5,6

The Quick Fix device is a simple, predictable, and effective mechanism for achieving this correction for pseudo-Class IIIs,^33,34 and it can also be used for Class II patients to provide molar distalization using Class II elastic or mini-screw support.

Steps for inserting the Quick Fix Device

• Placement of a maxillary 2 x 4 pre-adjusted appliance.
• Initial alignment and leveling with .016 superelastic arch wire for two to five months.
• Place appropriate right and left Side Swipes into the maxillary molar tubes: the segment of wire is inserted from the mesial into the molar tube with the Side Swipe tube positioned mesial and buccal to the molar tube.
• Trim the excess wire of the Side Swipe just flush to the molar tube and tie back with an elastic or stainless-steel ligature tie (optional).
• Place universal arch locks 36 mm apart (to fit distal to the maxillary lateral incisors) on a .0175-inch by .025-inch stainless-steel arch wire.
• Slide two 20 mm open-coil springs on the arch wire up to each arch lock.
• Insert this Quick Fix wire assembly into the tube of the Side Swipes and seat the wire in the brackets on the incisors.
• Consolidate the incisors with stainless-steel laced ligature to prevent unintended anterior space opening.
• Slide the arch locks distally along the arch wire to compress the open coil springs until the arch locks are between the first and second primary molars. Then tighten the locks to maintain the spring activation for incisor advancement.
• Cut the distal end of the arch wire flush to the distal end of the molar tube, not the Side Swipe tube. In this manner, about 4–5 mm of arch wire is adjacent to the molar tube and provides sufficient wire for incisor advancement.

Fig. 5: Right and left Side Swipe auxiliaries are placed into typical bonded or banded first molar tubes. The wire segment of the Side Swipe is inserted into the molar tube from the mesial, with the rectangular tube of that auxiliary oriented to the buccal. The Side Swipe is secured to the molar tube by tying a stainless or alastic ligature from the hook on the auxiliary to a hook on the molar tube. The Quick Fix wire assembly (stainless-steel wire, arch locks, open coil springs) is then inserted into the Side Swipe tube where the distal part of this “traveling” arch wire is positioned adjacent to the molar tube. The rectangular arch wire is seated into the brackets on the incisors and ligated into place using a stainless ligature lacing to prevent unwanted space opening.

Fig. 6: The Quick Fix wire assembly consists of a 0.017-inch by 0.025-inch stainless-steel arch form, two universal arch locks positioned 36 mm apart (to position them distal to the maxillary lateral incisors and permit wire seating) and two 20 mm lengths of 0.009-inch by 0.030-inch open coil spring.

Fig. 7: The arch lock is loosened and slid to the distal to compress the open coil spring. The lock is tightened at a position between the first and second primary molar. (Note: the distal extension of the arch wire was inserted into the Side Swipe tube and the remaining portion lies adjacent to the molar tube.)

Fig. 8: After the open coil spring has been
compressed, a distal end cutter is used to cut the distal extension of the arch wire just flush to the end of the molar tube, not the Side Swipe auxiliary. This provides for 4–5 mm of “traveling” arch wire to advance the incisors. The device is self-limiting as the wire will slip out of the Side Swipe after 4–5 mm of advancement.

Fig. 9: Resolution of an anterior crossbite in the transitional dentition for an 8-year old female. Leveling with 2X4 appliances required three months, followed by four months incisor advancement with the Quick Fix appliance.

Figs. 10a–e: Anterior crossbite resolved in seven months with combination of upper 2 x 4 appliance and Quick Fix appliance for an 11-year old male. At age 13, the patient was ready for some limited treatment to close spaces using full fixed appliances.

Fig. 11: An 8-year old male with a pseudo-Class III crossbite and associated functional shift, corrected by upper incisor advancement with a 2 x 4 and Quick Fix appliance in eight months. Five months of leveling and alignment was followed by three months of Quick Fix advancement.

Fig. 12a: Anterior crossbite resolved and arch length increased by simple advancement of the upper incisors using a combination of 2X4 and Quick Fix appliances in seven months (three months with the Quick Fix) for a 9-year-old female in the mixed dentition.

Fig. 12b: Note the improvement in upper lip support. Later correction in the permanent dentition will be relatively limited.

Fig. 13: Anterior crossbite and severe upper arch length discrepancy resolved using a combination of upper 2 x 4, MIA Quad Helix and Quick Fix appliance for an 8-year old male.

Editor’s note: Bowman has a financial interest in the Butterfly System and Quick Fix Kit.

*Quick Fix Kit™ with Side Swipes™ Ref #852-781, American Orthodontics, Inc., 1714 Cambridge Ave., Sheboygan, Wis. 53082-1048.

*MIA Quad Helix, AOA Laboratories, 13931 Spring St., Sturtevant, Wis. 53117.

**Butterfly Bracket System, American Orthodontics. 1714 Cambridge Ave., Sheboygan, Wis. 53082-1048

About the author

Dr. S. Jay Bowman is a diplomate of the American Board of Orthodontics, a member of the Edward H. Angle Society of Orthodontists, a fellow of both the American and International College of Dentists and the Pierre Fauchard Acadmey International Honor Organization, a charter member of the World Federation of Orthodontists and is a regent of the American Association of Orthodontists Foundation. He developed and teaches the Straightwire course at the University of Michigan, is an adjunct associate professor at Saint Louis University and is a clinical assistant professor at Case Western Reserve University. Contact him at drjwyred@aol.com.

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