Use of the pendulum appliance in managing Class II malocclusion with midline discrepancy: A case report

Abstract

The management of Class II malocclusions accompanied by midline deviation requires individualized approaches that balance treatment effectiveness with patient tolerance to orthodontic appliances. The Pendulum appliance is a fixed orthodontic device known as an effective and reliable method for maxillary molar distalization. This case report aims to describe the orthodontic treatment of an 11-year-old female patient presenting with a Class II malocclusion, midline deviation, and ectopic canine position on one side, using the Pendu-lum appliance. The treatment goal was to achieve controlled unilateral distalization to correct the midline shift. Following clinical and radiographic evaluations, a four-phase treatment protocol was followed for ap-proximately three years: molar distalization with the Pendulum appliance, spontaneous distalization of the premolars, space maintenance using a transpalatal (Nance) appliance, and finally, placement of fixed brackets. During treatment, the patient reported persistent discomfort due to the palatal component of the Pendulum, which caused oral hygiene challenges and mucosal irritation. The Pendulum appliance proved to be an effective solution for correcting a Class II malocclusion and midline deviation in a growing patient. However, appliance selection should always be based on individ-ual diagnosis, considering the type of malocclusion, patient age, and expected compliance. Further long-term studies with larger patient samples are needed to assess the stability of outcomes achieved with the Pendulum, especially in cases involving midline correction.