Enhanced Pendulum Appliance With TAD Anchorage In Molar Distalization

This case report describes a novel orthodontic approach utilizing an enhanced pendulum appliance with temporary anchorage. The technique addresses severe maxillary crowding and skeletal Class III malocclusion in a 20‐year‐old female, offering an alternative to surgical intervention. The patient presented with severe maxillary crowding, anterior crossbite, and open bite. Camouflage treatment was chosen after the patient declined surgery. Treatment involved extraction of select premolars and lingual inclination of the mandibular incisors to improve esthetics and biomechanics. An enhanced pendulum appliance—incorporating a TAD-based Nance arch with bonded miniscrews and dual activation helices on each spring—was used to achieve controlled molar distalization while minimizing unwanted buccolingual movements. Over 17 months, satisfactory alignment and Class I canine and molar relationships were established. The modified appliance design provided absolute anchorage and produced opposing forces via dual helices, effectively reducing molar tipping and lingual displacement. This innovative method simplified clinical procedures and shortened treatment duration compared to conventional techniques. Cephalometric and radiographic evaluations confirmed significant molar distalization and favorable retraction of the mandibular incisors. Stable treatment outcomes at a 2-year follow-up underscore the appliance’s effectiveness in complex malocclusion cases. This enhanced pendulum appliance offers a valuable non-surgical alternative for achieving optimal occlusal and facial improvements in adult patients.