Abstract:
Mandibular attachment structure for use in an orthodontic assembly having a force member connecting the mandibular and maxillar portions of the assembly and method of using the same. The structure includes bands dimensioned to encircle corresponding lower molars on opposite sides of the tongue, and threadless couplers each of which is removably or releasably affixed to a buccal side of a corresponding band. Neither the structure nor the method requires the use of an orthodontic brace to maintain a pressing connection between the structure and the rest of an orthodontic assembly, but the use of orthodontic braces is accommodated. The pressing connection is maintained by cooperating a hook at the end of the force member and a hook at the end of a threadless coupler.

Description:
RELATED APPLICATIONS 
       [0001]    This application is a Continuation-in-Part of U.S. patent application Ser. No. 13/777,866 filed on Feb. 26, 2013, entitled “Mandibular Attachment for Correction of Malocclusion”. The disclosure of the above-identified patent application is incorporated by reference herein in its entirety. 
     
    
     TECHNICAL FIELD 
       [0002]    The present invention is in the field of orthodontics and, more particularly, it relates to devices for correction of class II malocclusions. 
       BACKGROUND ART 
       [0003]    Orthodontics is a specialized field of dentistry that involves the application of mechanical forces to urge poorly positioned or crooked teeth into correct alignment and orientation. Orthodontic procedures can be used for cosmetic enhancement of teeth, as well as medically necessary movement of teeth. The orthodontic treatment of some patients includes correction of the alignment of the upper dental arch relative to the lower dental arch. Some patient have a condition referred to as Class II malocclusion or overjet, when the lower dental arch is located an excessive distance rearward of the upper dental arch when the jaws are closed. Other patients may have an opposite condition referred to as a Class III malocclusion (or negative overjet) when the lower dental arch is located forward of the upper dental arch when the jaws are closed. 
         [0004]    Class II and Class III malocclusions may be corrected with the use of a head-gear (the effectiveness of which is almost entirely dependent on patient&#39;s compliance) or with a force-applying system such as an intraoral force module, for example. The force-applying system, when operably installed in the patient&#39;s mouth, enables the exertion of either a pulling force or a pushing force on the upper and lower jaws to which it is attached to move the jaws towards each other or away from each other. 
         [0005]    Some known force-applying appliances are of complicated design and usually have a spring element that, in operation, requires to be repositionably attached to an auxiliary component such as an orthodontic brace to effectuate a progressive jaw correction. Other appliances employ an elastomeric member rather than a spring element, the cooperation of which with a metallic structure attaching such element to the teeth via molding or adhesive may loose its strength over time. In yet another case, the rigid affixation between the maxillar and mandibular portions of an appliance requires the use of threads and/or pins and requires a labor-intensive initial placement on the teeth and is subject to breakage and increased treatment times. Therefore, while the advantageous use of an intraoral force module has been recognized, there are still opportunities for substantial improvements. 
       SUMMARY 
       [0006]    Embodiments of the present invention provide a method for using an orthodontic assembly that contains a maxillar attachment structure, a mandibular attachment structure, and a force member. The method includes (i) securing the mandibular attachment structure in removable cooperation with lower molar teeth of the patient, and (ii) pressingly connecting the maxillar and mandibular attachment structures by threadlessly cooperating the force member to a free proximal end to exert a force onto a lower molar tooth in a direction suitable to correct Class II malocclusion condition as the patient&#39;s mouth closes. The mandibular attachment structure has first and second bands each dimensioned to surround a corresponding lower molar tooth, a single arched member the ends of which are fixedly secured to posterior sides of the bands, and first and second connector portions each fixedly secured to an anterior surface of a corresponding band at a distal end and having a free proximal end. The single arched member is disposed on a posterior side of the lower teeth and wherein free distal ends of the first and second connector portions extend towards a middle of the patient&#39;s dental arch. 
         [0007]    Embodiments of the present invention additionally provide a mandibular attachment structure for use in an orthodontic assembly, which includes first and second bands each dimensioned to surround a corresponding lower molar tooth; and a single arched member connected at its ends to first sides of the bands and extending, when operably installed in a patient&#39;s mouth, along a lingual side of the lower teeth. The first sides of the bands are associated with the lingual side of the lower teeth. The attachment structure additionally includes first and second threadless couplers, a first end of each of which is affixed to a labial side of a corresponding band. Each of the first and second threadless coupler extends along the single arched member, and the mandibular attachment structure is devoid of an orthodontic brace. 
         [0008]    Embodiments of the present invention also provide an improvement to an orthodontic force module for use in correcting class II and/or class III malocclusions. The orthodontic force module at hand, which is devoid of an elastomeric member, has having a maxillar attachment structure affixable to two upper molar teeth with the use of upper crown bands each substantially encircling a crown of a corresponding upper molar tooth, two lower crown bands each substantially encircling a crown of a corresponding lower molar tooth. The module also includes a coupling member enabling, in operation, a forced connection between the maxillar attachment structure and the two lower crown bands. The improvement includes a single arched member secured at its end to lingual sides of the lower crown bands, where the single arched member has a retainer clasp that enables, in operation, engagement of a premolar tooth at a lingual side thereof when the so connected single arched member is operably installed in the patient&#39;s mouth. The improvement additionally includes first and second connector portions each secured to a labial surface of a corresponding lower crown band at a distal end and having a proximal end that is enabled to threadlessly cooperate with the coupling member such that a force, created through the forced connection between the maxillar attachment structure and a lower crown band, is not applied to an orthodontic brace. 
         [0009]    Further embodiments of the present invention also provide a removable and releasable coupler between a molar band and maxillary anchored force transmitting member. Such a coupler is usable in conjunction with a buccal tube or buccal tube assembly from which it is removable. This allows for easy installation and replacement, while maintaining a threadless connection to a force member, while at the same time accommodating braces. The coupler is used in conjunction with a molar band and a buccal tube to constitute a mandibular assembly. The use of such a mandibular assembly allows for the correction of class II malocclusions at any stage of dentition. The device according to such embodiments may be used with or without braces, and with or without a lingual bow. 
         [0010]    Exemplary embodiments include an attachment structure for transmitting mesially directed force to a molar. The attachment structure includes a molar band dimensioned to surround a corresponding lower molar tooth and a buccal tube assembly affixed to a buccal side of the molar band. The buccal tube assembly has a lip bumper tube, and optionally, another tube to accommodate a brace arch wire. The structure also includes a coupler having a straight interface portion sized to slidingly and releasably engage a cylindrical interior volume defined by the lip bumper tube. The coupler also includes a posterior loop portion proximate to the straight interface portion, the posterior loop portion limiting the travel of the straight interface portion in a mesial direction through the lip bumper tube. The coupler also has a posterior straight portion proximate to the posterior loop portion, an offsetting portion proximate to the posterior straight portion and an anterior straight portion proximate to the offsetting portion. The coupler is terminated in a free anterior end including a posterior facing hook, which serves as an attachment means to a force transmitting member. The coupler may be secured to the buccal tube with flanges located on the posterior straight portion which engage a hook on the buccal tube when the coupler is rotated in the lip bumper tube during assembly. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0011]    The invention will be more fully understood by referring to the following Detailed Description of Specific Embodiments in conjunction with the Drawings, of which: 
           [0012]      FIGS. 1A and 1B  are diagrams illustrating Class II malocclusion and Class I normal occlusion. 
           [0013]      FIGS. 2A ,  2 B, and  2 C are diagrams illustrating schematically a structure and cooperation of portions of M.A.R.A. orthodontic appliance. 
           [0014]      FIGS. 3A ,  3 B are diagrams illustrating schematically a structure and cooperation of portions of Forsus orthodontic appliance. 
           [0015]      FIGS. 4A ,  4 B,  4 C, and  4 D are diagrams illustrating schematically a structure and cooperation of portion of an orthodontic appliance according to an embodiment of the invention. 
           [0016]      FIGS. 5A ,  5 B,  5 C,  5 D,  5 E and  5 F are diagrams illustrating schematically a structure and cooperation portion of an orthodontic appliance according to an embodiment of the invention. 
       
    
    
     DETAILED DESCRIPTION 
       [0017]    Class II malocclusion occurs in approximately 33% of the general population in the United States and presents a challenge for the orthodontist. In reference to  FIG. 1A , Class II malocclusion occurs when the lower jaw is deficient in length and sits behind the upper jaw. Not only can this compromise proper function, but often times can be a contributing factor to a less attractive smile and profile appearance.  FIG. 1B  presents, for comparison, a depiction of normal occlusion (Class I). Historically, a Class II occlusion has been treated effectively with headgear appliances that are best utilized when a patient is a still-growing child. The conventional headgear serves to maintain the position of the upper jaw while the lower jaw expresses its natural growth in a forward direction, and therefore correcting the occlusion. However, the downside of the headgear appliance is that it is unattractive, and its success is entirely dependent upon patient compliance; something that has been and continues to be an ongoing problem in orthodontics. 
         [0018]    The intra-oral force-applying appliances of related art used as alternatives to head gear have certain limitations. For example, many such devices are of complex design, requiring a number of moving parts (such as pins, for example), and cannot be easily installed in the correct location in a patient&#39;s mouth. Additionally, many intra-oral devices for occlusion correction are not easily adaptable to being employed during the period of growth spurts of the patient (ranging anywhere from as early as 8.5 years in females to as late as 14 years in males) in either the mixed dentition or permanent dentition periods. Many such devices, for example, require permanent dentition prior to installation, at which point much of a patient&#39;s growth is already over, which limits the efficacy of the devices. 
         [0019]    Additionally, it is sometimes advantageous for such intra-oral orthodontic appliances to be configured to be independent from the usage of orthodontic braces and to enable the malocclusion correction with or without orthodontic braces placed on the patient&#39;s teeth. The orthodontic brackets and wires, which together are commonly referred to as “braces”, include small slotted bodies configured to be directly attached to the patient&#39;s teeth or, alternatively, to be attached to bands which are, in turn, cemented or otherwise secured around the teeth. Once the brackets are affixed to the patient&#39;s teeth, a curved wire is inserted into the bracket slots. The brackets and the arch wire cooperate to guide corrective movement of the teeth into proper alignment. Typical corrective movement provided by the braces include torque, rotation, and leveling of the teeth. An example of orthodontic appliance that cannot be used at the same time when a patient wears orthodontic braces prescribed by the dentist is provided by the so-called Higgins Crossbow appliance that requires the use of two arched members one of which is extended along the labial side of the teeth where an orthodontic bracket would be placed. Other appliance, such as the Forsus appliance, discussed in more detail below, require the installation of braces for use. 
         [0020]    To illustrate some devices of related art,  FIGS. 2A ,  2 B and  2 C provide diagrams of components of the M.A.R.A. appliance, showing the maxillar and mandibular portions  210 ,  220  fixed on molar teeth of the upper and lower molar teeth, respectively, with crowns  230 ,  232 . While  FIGS. 2A ,  2 B offer perspective views of the appliance attached to teeth in the open mouth of the patient,  FIG. 2C  illustrates a substantially side view of the mouth that is equipped with the appliance and the jaws of which are closed. To form a connection between the upper and lower jaws, when the patient&#39;s mouth is closed, the crown  230  of the maxillar portion  210  is equipped with a tube bracket  234  that is dimensioned to removably accept a pin  236  having a first portion  236 A insertable into a hollow of the bracket  234  and a second portion  236 B extended transversely to the first portion  236 A. The crown  232  of the mandibular portion  220 , in turn, is fixedly equipped with a stopper  240  extending and defined in a surface (substantially corresponding to the xy-plane of  FIG. 2C ) that is transverse to a labial surface  242  of the crown  232  to provide support to which, as shown in  FIG. 2C , the second portion  236 B of the pin  236  is pressed and against which the second portion  236 B applies force in operation. While this appliance can be employed in the mixed or permanent dentition and with or without braced placed on the teeth, the outward extension of the stopper  240  from a tooth toward a lip of the mouth and a need to secure the pin  236  in a tube bracket  234  (for example with a rubber band  250 , as shown in  FIG. 2C ) unnecessarily complicate its practical use. 
         [0021]    The Forsus appliance, illustrated in diagrams of  FIGS. 3A ,  3 B can only be used when the patient has all of his or her permanent teeth erupted and braces  310  are placed on all teeth. As shown in  FIG. 3B , the spring member  320  that connects the maxillar and mandibular portions  330 ,  340  of the Forsus appliance, requires affixation to a wire  354  of the orthodontic brace  310  at least at one end. As shown at  356 , such affixation is achieved with the use of a hook or loop  358  formed at an end of the member  320 , which slides along the wire  354 . (While the spring member  320  is illustrated as a coil spring, a related (not shown) structure may employ a leaf-spring or a spring structured as a bent rod.) A significant number of patients are well past their growth spurt by the time all upper and lower permanent teeth have erupted, thus limiting the amount of skeletal correction that can be achieved and rendering the current model of the Forsus appliance not particularly effective for many patients. Additionally, in operation hook or loop  358  formed at the end of member  320  of the Forsus appliance exerts force on at least one bracket of the brace  310  to which it is affixed. As a result, breakage or loss of adhesion of the brace brackets is common with the Forsus appliance, which requires frequent office visits to repair. 
         [0022]    Embodiments of the present invention provides an orthodontic appliance that alleviates the above-identified problems and limitations of operation and enables the Class II and/or Class III malocclusion correction during the mixed dentition phase, without reliance on, or damage to, an orthodontic brace. 
         [0023]    Referring now to  FIGS. 4A through 4D , an embodiment of the invention includes a mandibular attachment structure  410  that is devoid of elastomeric material and that is affixable to the first and second lower molar teeth with the use of bands  412 ,  414 , each of which is appropriately dimensioned to surround a corresponding lower molar tooth. According to the idea of the invention, the interconnection of the bands  412 ,  414  is configured on only the lingual side of the embodiment. Accordingly, the bands  412 ,  414  are linked with a single arched member  418  (made, in one implementation of a wire) the ends of which are securely affixed to anterior, lingual sides of the bands  412 ,  414 . The arched member may optionally be equipped with at least one (as shown—two) retainer clasp  420  that, in operation (when the embodiment is installed into a patient&#39;s mouth), enables the engagement between the arched member  418  and a premolar tooth on its lingual side. To a labial side of each of the bands  412 ,  414  a corresponding connector or coupler  422 ,  424  is secured (for example, by soldering) that is extended along a corresponding jaw toward the middle of the patient&#39;s dental arch (labeled as  430 ). Portions of the connectors  422 ,  424  that are distal to the bands  412 ,  414  may be transversely offset from the bands by offset sections  432 ,  434 , and are terminated with attachment means that are devoid of threads, such as, for example, hooks  442 ,  444 . 
         [0024]    The embodiment of the invention may additionally include a maxillar attachment structure  450  containing a band affixing the maxillar structure to an upper molar tooth. The embodiment may further include force member(s)  452 ,  454  (including, for example, a coil or leaf or rod spring) configured to be affixable to the maxillar attachment structure  450  (through, for example, a pin or clasp fitting to an appropriate receiving portion of the maxillar attachment structure such as a tube bracket or a hook) at one end and threadlessly and pinlessly cooperating with the attachment means  442 ,  444  of the mandibular structure  410 . In operation, when both the mandibular structure  410  and the maxillar structure  450  are installed in the patient&#39;s mouth and connected to the force member(s)  452 ,  454 , and when the patient closes his jaws, the force member(s)  452 ,  454  pressingly connect the structures  410  and  450  to exert a force on lower molar teeth (through the couplers  422 ,  432  and the bands  412 ,  414 ) in a direction suitable to correct Class II or Class III malocclusions. The force applied to the lower jaw is progressively adjustable by adjusting the tension in the force member(s)  454 . In contradistinction with devices of the related art, such transfer of force does not require the presence and/or use of orthodontic braces and can be used contemporaneously with the use of these braces or at a time when the braces are not prescribed. Moreover, the fact that the attachment elements  442 ,  444  of the mandibular structure  410  are devoid of protrusions or excursions that are transverse to the labial side of the brackets  412 ,  414  improves patient&#39;s comfort in wearing such orthodontic appliance, as compared to the M.A.R.S. appliance, for example. 
         [0025]    In one implementation, the mandibular portion  410  of the article of the invention can be used as an attachment for the Forsus arms of a portion of the Forsus appliance during the mixed dentition, thereby increasing the effectiveness of the Forsus appliance and extending its use to a greater number of patients. The method for using an orthodontic assembly according to an embodiment of the invention includes securing the mandibular attachment structure of the invention in removable cooperation with lower molar teeth of the patient such as to surround these teeth with first and second bands  412 ,  414  of the mandibular structure, to place the arched member  418  of the lingual side of the lower teeth and to position the connector or couplers  422 ,  432  on the labial side of the lower teeth with the hooks  442 ,  454  extending towards the middle  430  of the dental arch of the patient. 
         [0026]    As can be seen in  FIGS. 4C and 4D , in those embodiment, couplers  422 ,  424  are provided in the form of a rigid, non-compressible, non-extensible wires that terminate in attachment means, for example, posterior facing hooks  442 ,  444 . In practice, the device of  FIGS. 4C and 4D  is fabricated by having a third party laboratory solder couplers  432 ,  434  to the corresponding molar bands. The result is that couplers  432 ,  434  are permanently affixed to molar bands  412 ,  414 . 
         [0027]      FIGS. 5A-F  show an alternative to the arrangement of  FIGS. 4A-D , which uses a removable coupler as part of the mandibular attachment structure, rather than a coupler that is permanently affixed to the molar band. As can be seen in  FIG. 5A , this embodiment includes a molar bands, for example, molar band  512 , which is appropriately dimensioned to surround a corresponding lower molar tooth. A buccal tube  560  is affixed to a buccal surface of molar band  512 . As will be described in additional detail in relation to  FIG. 5C , buccal tube  560  includes a tubular portion  562 , which defines a cylindrical volume with the long axis of the cylindrical volume being oriented in a mesial direction. Coupler  522  is provided, which has a posterior loop portion  564 , which includes an anterior facing loop, and a straight interface portion  566  sized to slidingly engage the interior surface of the tube portion  562  of buccal tube  560 . Coupler  522  includes a serpentine offsetting portion  556 , which provides for clearance between coupler  522  and the canine and pre-molar, if necessary, depending on the length of coupler  522 . Coupler  522  includes a free anterior end, which forms an attachment means  542 . In the arrangement of  FIG. 5A , attachment means  542  is arranged as a backward or posterior opening or facing hook. In certain installations, the use of molar band  512  in conjunction with buccal tube  560  enables the device to optionally be used in conjunction with brace arch wire  575 , which may be affixed to another tube or slot defined by buccal tube  560 . In practice, as in the embodiment of  FIGS. 4A-D , the device of  FIG. 5A  is used in a pair, as is shown in  FIG. 5B . A pair of molar bands according to the arrangement of  FIGS. 5A and 5B  may optionally be joined by a non-illustrated lingual bow, such as arch member  418  described above. However, it is important to note that there may be advantages to omitting the lingual bow  418 , which are described more fully below. Both the use of a lingual bow, and the absence of a lingual bow are within the scope of the invention. 
         [0028]      FIG. 5B  illustrates the interface of the device of  FIG. 5A  with a force transmitting device or member, such as a Forsus appliance. As in the arrangement described above with respect to  FIG. 4A , a maxillar attachment structure  550  containing a band affixing the maxillar structure to an upper molar tooth is provided. A force member  552  (including, for example, a coil or leaf or spring loaded telescoping rod) is provided which is configured to be affixable to the maxillar attachment structure  550  (through, for example, a pin or clasp fitting to an appropriate receiving portion of the maxillar attachment structure such as a tube bracket or a hook) at one end. The force member threadlessly and pinlessly cooperates with the attachment means  542  of the coupler  522 . In operation, when both the mandibular structure (shown in  FIG. 5A ) and the maxillar structure  550  are installed in the patient&#39;s mouth and connected to the force member  552 , and when the patient closes his jaws, the force member  552  pressingly connects the structures  550  and the structures of  FIG. 5A , to exert force on the lower molar (through the coupler  522  and the molar band  512 ) in a direction suitable to correct Class II malocclusions. In this embodiment, the force applied to the lower jaw is progressively adjustable by adjusting either or both of the tension in the force member(s)  552  and/or the length of the coupler  522 . 
         [0029]      FIG. 5C  shows a mandibular structure (i.e., a molar band affixed to a buccal tube) of one embodiment of the invention in greater detail. As can be seen in  FIG. 5C , a mandibular attachment or anchor structure includes a molar band  512  sized to fit over, for example, a patient&#39;s first molar. Affixed on a buccal side of the molar band  512  is a buccal tube or buccal tube assembly  560 . In the embodiment of  FIG. 5C , buccal tube  560  is a double tube that defines a first tube or channel  561  and a second tube  562  to a buccal or outside side of the first tube  561 . Second tube  562  may be a “lip bumper tube”. First tube  561  is optionally usable for passage or anchoring of a brace arch wire, such as  575 . Both tubes  561 ,  562  define closed channel regions that are oriented along an axis parallel to an axis extending in the mesial direction. Buccal tube  560  also includes a hook  563 , which along with second tube  562 , is used to locate, orient and anchor a coupler, such as coupler  522  described above. 
         [0030]    As is set forth in more detail below with respect to  FIGS. 5E and 5F , coupler  522  is releasably or removably joined to buccal tube  560  by sliding straight interface portion  566  of coupler  522  into the second tube  562  such that substantially the entirety of the straight interface portion  562  overlaps with the second tube  562 . When this step is performed, the coupler is clocked such that loop of posterior loop portion  564  is disposed in the plane of the mandibular teeth. In other words, during installation, the coupler  522  is rotated 90 degrees from the final installed orientation that is depicted in  FIG. 5A . Beyond the straight interface portion  566  (i.e., posterior of straight interface portion), coupler  522  includes a posterior loop portion  564  which interferes with further passage of the straight interface portion  566  of the coupler as it is slid into the second tube  562  in a mesial or anterior direction. Thus, once the coupler “bottoms out” (i.e., once the transition zone between the straight interface portion  566  and the posterior loop portion  564  interferes with continued forward passage of the straight interface portion  566  into the second tube  562 ), the coupler  522  is releasably anchored to the buccal tube  560  by rotating coupler  522  about the long axes of the second tube  562 /straight interface portion  566 , until it is in the orientation depicted in  FIG. 5A . One or more flanges  555  are disposed on the surface of coupler in a straight region posterior to the serpentine offsetting portion  556 . Upon rotation of the coupler  522  into the installed orientation of  FIG. 5A , these flanges  555  engage hook  563  to secure coupler  522  to buccal tube  560 . For additional security, an elastic band  570  or stainless steel ligature tie may be placed in the manner shown in  FIG. 5D . 
         [0031]      FIGS. 5E and 5F  illustrate coupler  522  in additional detail. In one exemplary embodiment, coupler  522  is fabricated from a single piece of 1.2 mm diameter stainless steel wire. Coupler  522  has a straight interface portion  566 , which transitions to a posterior loop portion  564 , which defines an anterior-facing loop. Posterior loop portion  564  transitions to a posterior straight portion  557 , into or onto which are disposed one or more flanges  555 . Straight interface portion  566  and posterior straight portion  557  are not co-planar, rather, in one exemplary embodiment, there is a 10 degree angle between the axes of these straight portions. Because buccal tube  560  (and more particularly, second tube  562 ) captures straight interface portion  566 , the effect of this 10 degree offset angle is that when installed, coupler  522  is angled away from the buccal surfaces of the adjacent teeth. Posterior straight portion transitions through serpentine offsetting portion  556  to an anterior straight portion  558 , which then transitions to attachment means  542 . In the embodiment of  FIGS. 5A-5F , attachment means  542  is realized as a posterior facing loop or hook. While the loops of attachment means  542  and posterior loop portion  564  are arranged in parallel planes, they are not co-planar because serpentine offsetting portion  556  serves to introduce an offset in the planes in which these loops are defined. In the embodiment of  FIG. 5F , this offset is 2 millimeters. 
         [0032]    The removable hook coupler  522  described above provides the clinician and patient with many advantages over the embodiment of  FIG. 4 , as well as conventional appliances, such as the Herbst and Higgins Cross Bow appliances. One advantage is that the device of  FIG. 5  can be used during any stage of the dentition, with or without braces placed on the patient, and can even be placed without having to be sent to a laboratory first. In addition, it is the only class II functional appliance that has the ability to close space in the mandibular arch by mesializing the first molar and second premolar without distalizing any of the mandibular anterior teeth. 
         [0033]    The Higgins Cross Bow appliance cannot be placed on patients who have mandibular braces due to the interference that would take place between the braces and the labial bow on the Higgins Cross Bow appliance. When the clinician is trying to achieve class II correction at a relatively early stage this is not an issue because the patient usually is not fitted with mandibular braces. Often times, however, a patient doesn&#39;t present to an office until all the permanent teeth have erupted, which results in the both the clinician and patient wanting to expedite treatment by trying to align all teeth and get class II correction at the same time. This situation excludes the Higgins Cross Bow appliance from being used and leaves only the traditional Forsus appliance, Herbst appliance (special version), or class II elastics for class II correction. 
         [0034]    However, the device of  FIG. 5  has advantages over those conventional solutions. The Herbst appliance requires lab fabrication, is very bulky, and has a high breakage rate. The Forsus appliance is easy to place but attaches directly to the mandibular archwire and presses against either the distal surface of the mandibular first bicuspid bracket or the distal of the mandibular canine bracket, which can be seen in  FIG. 3B . Because of the significant force the Forsus rod applies it often results in broken mandibular first bicuspid and canine brackets, which can significantly increase treatment times. Class II elastics only provide a minimal amount of molar correction due to their limited force and only when the patient fully complies with instructions, which almost never happens. 
         [0035]    In contrast, the removable coupler of  FIG. 5 , can be placed at anytime during treatment with braces and only requires clinicians use a mandibular first molar band with a lip bumper tube attachment. The coupler  522  is designed such that the retention bumps or flanges  555  on the hook will snap into the buccal tube hook  563  when inserted into the distal end of the lip bumper tube at an angle of approximately 90 degrees away from the buccal tube and then rotated 90 degrees toward the buccal tube and into its final upright position (shown in  FIG. 5A ). After securing the hook in with a 0.012″ stainless steel ligature tie the clinician or orthodontic technician simply places the Forsus rod directly onto the coupler, bypassing the wire and braces and thereby eliminating the chance of breaking brackets while the Forsus rod is in use. 
         [0036]    Another advantage of the device of  FIG. 5  is the ability to utilize the Forsus Appliance along with the removable coupler  522  in order to achieve class II correction and close mandibular space. No other appliance known to the applicant can achieve similar correction. Because, in certain embodiments, there is no soldered lingual bar (e.g.,  418 ) on the mandibular first molar band that rests against the lingual surface of the mandibular anterior teeth, the mandibular molar tooth can move forward (mesial) when the Forsus appliance (or any other force member) is attached. The Herbst appliance, Higgins Cross Bow appliance, in contrast, all have soldered lingual bars that prevent any space closure. 
         [0037]    There are many class II, crowding cases where the clinician will extract the maxillary first bicuspid teeth as well as the mandibular second bicuspid teeth in order to alleviate crowding in both arches and correct a class II molar relationship. Traditional methods involve using class II elastics, but as mentioned above, such conventional treatments come with many limitations and rely solely on patient compliance. The Forsus Appliance along with the removable coupler of  FIG. 5  provides superior class II correction and mandibular space closure with minimal breakage and easy installation. 
         [0038]    While the invention is described through the above-described exemplary embodiments, it will be understood by those of ordinary skill in the art that modifications to, and variations of, the illustrated embodiments may be made without departing from the inventive concepts disclosed herein. Furthermore, disclosed aspects, or portions of these aspects, may be combined in ways not listed above. Accordingly, the invention should not be viewed as being limited to the disclosed embodiment(s).