Case Report

The Churro Jumper: A Reliable Substitute for Mid Course Correction during Fixed Functional Therapy – A Case Report

Sonali Rathore1 and Tariq Ansari2*
1Department of Orthodontics, Malla Reddy Institute of Dental Science, Ramaiah Dental College, India
2Department of Orthodontics, Yenepoya Dental College, Yenepoya University, India


*Corresponding author: Tariq Ansari, Department of Orthodontics, Yenepoya Dental College, Yenepoya University, India


Published: 27 Jun, 2017
Cite this article as: Rathore S, Ansari T. The Churro Jumper: A Reliable Substitute for Mid Course Correction during Fixed Functional Therapy – A Case Report. J Dent Oral Biol. 2017; 2(8): 1056.


Abstract

Introduction: This case report deals with the correction of a skeletal and dental class II division 1 malocclusion case.
Materials and Methods: The patient was treated with 0.022 inch slot 3M metal bracket system, along with this the Jasper jumper was placed to help bring about the necessary correction of the class II skeletal malocclusion.
Result: The necessary correction was achieved without the need for extraction.
Conclusion: The Churro jumper is a helpful device to bring about necessary correction of class II malocclusion with acceptable results.


Introduction

With the soft tissue paradigm shift, several factors are being considered during the initial diagnosis of an orthodontic case. The facial aesthetics are taking priority over the ideal dental norms. This helps to evaluate the final treatment plan and to address the issue of requirement of extraction of teeth. In 1998, Castanon et al. [1] developed the Churro jumper. This fixed functional appliance was easy to fabricate and was to be an economical solution to the more expensive alternatives on the market.


Case Presentation

Diagnosis
A 15-year-old male patient reported to the clinic with the chief complaint of proclined upper teeth. He was diagnosed as having class II division 1 malocclusion with proclined maxillary anterior teeth with visible spacing and also a retrognathic mandible (Figures 1-4). As the visual treatment objective was noted to be positive, mandibular repositioning was decided to be the best course of action with a non extraction treatment plan. An MBT prescription metal bracket system with a 0.022” bracket slot was used. The initial leveling and aligning was completed using the light gauge wires, followed by rectangular NiTi arch wires and rectangular stainless steel arch wires (Figures 5-10). After the teeth were judged to have attained the proper tip and torque, the Jasper jumper appliance was placed [2].
In about 2 months of placement of the Jasper jumper appliance the patient had arrived to the clinic with a broken appliance and did not prefer to have it replaced. We were on the lookout for a more economical solution. The Churo jumper seemed to be a logical substitute due to its ease of fabrication and because it the suited the patients affordability. Therefore, the Churo jumper was selected as a substitute to the Jasper jumper (Figure 11 and 12).
Construction of the Churo jumper
The linear measurement was performed between the distal aspect of the mandibular canine and the mesial aspect of the maxillary first molar; the 10 mm was added to this length and was considered to the required length of the appliance. A wire of 0.028” was used to fabricate this appliance. About 15 coils were fabricated and placed between the maxillary first molar and the mandibular canine. A polyvinyl impression material was injected into the lumen of the coils with the help of a syringe. This step is performed in order to prevent pinching of the cheeks by the appliance. The distal ends of the pain arch wire are cinched distal to the molar brackets. The appliance is placed after the leveling and aligning phase is completed (Figures 13- 24).


Figure 1

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Figure 1
Extra oral – frontal.

Figure 2

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Figure 2
Extra oral frontal – smile.

Figure 3

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Figure 3
Extra oral – profile.

Figure 4

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Figure 4
Extra oral three quarter.

Figure 5

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Figure 5
Intraoral frontal.

Figure 6

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Figure 6
Intraoral left buccal view.

Figure 7

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Figure 7
Intraoral maxillary occlusal.

Figure 8

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Figure 8
Intraoral mandibular occlusal.

Figure 9

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Figure 9
Pretreatment profile view.

Figure 10

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Figure 10
Visual treatment objective: positive.

Figure 11

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Figure 11
Jasper jumper – intraoral frontal view.

Figure 12

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Figure 12
Jasper jumper – buccal view.

Figure 13

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Figure 13
Churo jumper – intraoral frontal view.

Figure 14

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Figure 14
Churo jumper – intraoral bucaal view left.

Figure 15

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Figure 15
Churo jumper – intraoral buccal view right.

Figure 16

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Figure 16
Post treatment extra oral.

Figure 17

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Figure 17
Post treatment extra oral smiling.

Figure 18

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Figure 18
Post treatment extra oral profile.

Results

The proclined upper anterior teeth were corrected. The mandible was repositioned and the final post treatment profile was favorable. We were able to achieve competency of lips. The final dental position was determined to be a favorable class I malocclusion. The anchor loss was negligible (Table 1).


Figure 19

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Figure 19
Post treatment extra oral three quarter.

Figure 20

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Figure 20
Post treatment intraoral frontal.

Figure 21

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Figure 21
Post treatment intraoral buccal view right.

Figure 22

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Figure 22
Post treatment intraoral buccal view left.

Figure 23

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Figure 23
Post treatment intraoral maxillary occlusal View.

Figure 24

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Figure 24
Post treatment intraoral mandibular occlusal View.

Discussion

According to a research done by Bjork [3], any increase in the vertical facial height for a class II malocclusion patient would prove detrimental to the patient as the mandible rotates posteriorly and this causes worsening of the class II pattern. Therefore, if any orthodontic appliance was to cause a counter clockwise rotation of the mandible, it would help with the correction of the class II malocclusion and prevent it from worsening. This is the basis of correction of the class II malocclusion with the help of functional appliances (fixed or removable).
When the patient arrived to the clinic with the pre existing class II malocclusion and incompetent lips several treatment plans were considered. Considering the patient’s age and a positive visual treatment objective (VTO), a non-extraction treatment plan was proposed with the help of a fixed functional appliance. Several appliances were considered such as the Forsus appliance [4], the Eureka spring [5] and finally a decision was taken to use the Jasper jumper appliance. During the initial assessment period it was noted that the appliance was producing favorable results. After the patient broke the appliance, he was advised for replacement of the appliance but he found the solution expensive.
After a lot of contemplation, it was decided to use the Churo jumper as a favorable and economic replacement for the broken Jasper jumper. The Churo jumper was placed and the final results were self evident. The class II malocclusion was corrected and the patient was able to attain a class I malocclusion and a favorable profile.


Table 1

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Table 1
Anchor loss was negligible.

Conclusion

Although the fixed functional appliance therapy is effective and overcomes the shortcomings of patient compliance in traditional myofunctional therapy, they have certain limitations. The constant breakages and difficulty in patient acceptance are some of the problems faced by the orthodontic practitioner. The Churo jumper is an economic and reliable substitute for the more expensive fixed functional appliances in the market.


References

  1. Castañon R, Valdes MS, White LW. Clinical use of Churo jumper. J Clin Orthod. 1998;32(12):731-45.
  2. Jasper JJ, Mc Namra JA. Correction of inter arch malocclusions using a fixed force module. Am J Orthod Dentofacial Orthop. 1995;108(6):641-50.
  3. Bjork A. Prediction of mandibular growth rotation. Am J Orthod. 1969;55(6):39-53.
  4. Vogt W. The Forsus fatigue resistant device. J Clin Orthod. 2006;40(6):368-77.
  5. Devincenzo J. The Eureka spring: a new internal force delivery system. J Clin Orthod. 1997;31(7):454- 67.