fixed functional appliances

FIXED FUNCTIONAL
APPLIANCES
Presented by:
Dr Harish kumar,
PG II year,
Dept of orthodontics,
MIDS,
Nizambad.

CONTENTS
Introduction
 Definition
 History
 Indications
 Mode of action
Classification
 Based on mode of action
 Classification by RITTO KORRODI (2001)
 Based on type of force produced
Rigid FFA
Flexible FFA
Hybrid FFA
Conclusion

DEFINITION
o an appliance that produces all or part of its effect by altering the position of the
mandible
• Functional orthopedic treatment seeks to correct malocclusions and harmonize the
shape of the dental arch and orofacial function.
• Developed primarily in Europe by many clinicians in an affort to stimulate mandibular
growth, and aid in the correction of skeletal class-2 malocclusions
• It is intended to alter mandibular growth.
DEFINITION

Disadvantages of removable functional appliances
X Very bulky,
X Have unbalanced fixation,
X Absence of tactile sensibility, comfort,
X Apply pressure on the mucosa (causing gingivitis),
X Cause problems in deglutition, speech
X Reduce space for the tongue & commonly affect facial appearance.

• Unfortunately due to the bulk and inconvenience, removable functional appliance fails to
attract the patient’s cooperation.
• In addition, their intermittent wear does not elicit continuous muscle activity , a factor that
is very essential for promoting skeletal change.
• Patient cooperation - an important factor, failure to adhere to prescribed schedules of
removable appliance wear will result in slow treatment response or no response at all.
• To reduce these factors the Fixed functional appliances were developed

HISTORY :
• NORMAN KINGSLEY - Bite plate
• Bite plate for jumping the bite.
• 1st to use the forward positioning of the mandible in orthodontic therapy.
• The bite plate was the forerunner of the modern functional appliances.
HISTORY

• Whereas Fixed functional appliances first appeared in 1910 when Emil Herbst
presented his system at the Berlin international dental congress.
• Since then and up to the seventies, very little was published on this appliance.
• It was at that time that Hans Pancherz brought the subject back into the
discussion with the publication of several articles on the Herbst in 1979.

“ NON-COMPLIANCE CLASS II CORRECTORS”
Fixed functional appliances are commonly called
as

 They are used full day, which implies
continuous muscle activity for
mandibular growth.
 They are smaller in size allowing better
adaptation to perform such functions
like swallowing, mastication, speech
and inhalation.
 allow greater control as they are fixed
on both the arches.
REMOVABLE FUNCTIONAL
APPLIANCE
FIXED FUNCTIONAL
APPLIANCE

HISTORY :
Functional appliance
Increased contractile activity of lateral pterygoid muscle
++ of RDP / Bilaminar zone
Increased growth stimulating fctors
Enhancement of local mediators
Reduction of local regulators (factors having –ve feedback effects on cell multiplication rate)
Change in condylar trabecular orientation
Additional growth of condylar cartilage
Additional subperiosteal ossification of post. Border of mandible
Legnthening of mandible
MODE OF ACTION

 The correction of skeletal anomaly in young
developing individuals.
a) In skeletal class II cases with retrognathic mandible.
b) In skeletal class III cases with retrognathic maxilla.
 Making use of the residual growth left in neglected
post-adolescent patients who have passed the
maximal pubertal growth and are too old for
removable functional appliances.
• .
INDICATIONS
 In adults patients
 Used in upper molars distallization to correct dental class
II molar relationship.
 Used to enhance anchorage.
 Used as mandibular anterior repositioning splint in
patients having Temporo-mandibular joint disorders
 Post-surgical stabilization of class II / class III
malocclusion.
 Functional midline shifts can be corrected by using the
appliance unilaterally.

Rigid FFA Hybrid FFA
Flexible FFA
• Herbst its modifications
• MARA
• MPA (I, II, III, IV)
• MARS
• IST
• Biopedic appliance
• Ritto app
• Magnetic Telescopeic
Device
• UBJ
• Hjasper jumper
• Adustable bite
corrector
• Churro jumper
• Amoric torsion coils
• Scandee tubular
jumper
• Klapper super spring
• Bite fixer (ormco)
• Flex developer
• Eureka spring
• Forsus
• Twin force bite
corrector
• Calibrated force module
• Alpern class II closer
Classification by Ritto korrodi (2001)

Intermaxillary non compliance
appliances
Intramaxillary non compliance
appliances
• Herbst , its
modifications
• Jasper jumper
• Eureka spring
• Adjustable bite
corrector
• Forsus
• Biopedic app
• MARA
• Pendulum app.
• Distal jet
• Repelling magnets
• Jones jig
Based on mode of action and type of
anchorage

PUSHING FORCE PULLING FORCE
• Herbst , its
modifications
• Jasper jumper
• Eureka spring
• Adjustable bite
corrector
• Forsus
• MARA
• SAIF Appliance
(Severable Adjustable
intermaxillary Force
Spring )
Based on type of force produced
• Jasper jumper
• Adustable bite
corrector
• Churro jumper
• Amoric torsion
coils
• Klapper super
spring
• Bite fixer (ormco)
• Flex developer

RIGID FIXED FUNCTIONAL
APPLIANCES

• Developed by Emil Herbst (1872 – 1940) in 1900s.
• He called his appliance “Okklusionsscharnier” or “Retentionsscharnier” (Sharnier
= Joint) and Retention was added since the upper part of the appliance served as
a retainer for an expanded maxillary dental arch.
• Herbst presented his appliance for the first time at the 5th international Dental
Congress in Berlin in 1909.
• It was rediscovered by Pancherz in the late 1970s
Herbst Appliance
( EMIL HERBST) – 1910

• The Herbst appliance is basically a fixed bite jumping device for the treatment of
skeletal Class II malocclusions.
• A bilateral telescope mechanism keeps the mandible in an anterior-forced
position during all mandibular functions such as speech, chewing, biting, and
swallowing.
• The telescope mechanism (tube and plunger) is attached to "orthodontic bands,
crowns, or splints.

• The tube is positioned in the maxillary first
molar region and the plunger in the
mandibular first premolar region.
• The telescopes allow mandibular opening
and closing movements and when
constructed properly lateral jaw movements
are also possible

• Each telescope consists of a tube, a plunger, 2 pivots
(axle), and two locking screws that prevent the
telescoping parts from slipping past the pivots.
• Length of the plunger should be kept at a maximum
to prevent it from disengaging from the tube.
• A large interpivot distance prevents the plunger from
slipping out of the tube when the mouth is opened
wide.

ORIGINAL HERBST DESIGN :
• Had the telescope mechanism placed upside down
(with plunger attached to the maxillary molar crown
and the tube on the mandibular canine crown).
• Tube had no open end , thus not allowing the
plunger to extend behind the tube.

• The telescoping parts of the Herbst appliance were curved conforming to Curve
of spee and were made of German Silver or gold( worn more than 6 months)

TIMING OF TREATMENT :
• Pancherz, Hagg, (1985)  Most favorable time - peak of pubertal growth spurt.
• Pancherz & Hagg (1988)  Indicated that the patients treated at the initial closure of
the middle phalanx of the third finger (MP3FG) had the greatest amount of condylar
growth
• Ruf, Pancherz (March 2003)  permanent dentition or just after the pubertal peak of
growth corresponding to the skeletal maturity stages FG to H of the middle phalanx
(implying the precapping to preunion stages of epiphysis and diaphysis)

• Perfect end result cannot be obtained exclusively with Herbst.
• Class II cases cannot be treated to a perfect end result with the Herbst appliance
exclusively.
• Many cases will require a subsequent dental-alignment treatment phase with a
multibracket appliance.

CLASS II DIV 1
ORTHOPEDIC PHASE.
ORTHODONTIC PHASE
The sagittal jaw base relationship is
normalized and the Class II
malocclusion is transferred to a Class I
malocclusion by means of the Herbst
appliance
Tooth irregularities and arch
discrepancy problems are treated with
a multibracket appliance (with or
without extractions of teeth).

CLASS II DIV 1
ORTHODONTIC PHASE.
ORTHOPAEDIC PHASE
ORTHODONTIC PHASE
Alignment of the anterior maxillary teeth
Transformation of the Class II malocclusion into a Class I
malocclusion
Tooth irregularities and arch-discrepancy problems

Herbst appliance indications:
 Most suitable in the treatment of Class II malocclusions with a retrognathic mandible
and retroclined lower incisors
 In young patients, so that growth might be influenced effectively.
 Maxillary and mandibular teeth should be well aligned and the dental arches should fit
each other in normal sagittal position

Skeletal changes
 The increase in mandibular length - due to condylar growth stimulation as an adaptive
reaction to the forward positioning of the mandible
 the gonion angle increased slightly. (This may be due to a more sagittally directed
growth of the condyle or it may result from resorptive bone changes in the gonion
region, probably as a consequence of an altered muscle function during bite jumping).
 Stimulating effect on mandibular growth + restraining effect on maxillary growth

Dental changes
 When jumping the bite, occlusal contacts existed only between the incisors while the
buccal segments were out of occlusion.
 Thus, vertical tooth eruption and growth in the posterior segments were allowed to
take place freely.
 This accounted for the reduction of overbite and the increase in lower facial height
found in the patients

HERBST VS ACTIVATOR
• Functional therapy with activators is often used to influence mandibular growth.
However, it has not yet been shown that treatment has any significant effect on
condylar growth.
• This can be explained by the fact that the activator is used only 10 to 12 hours a
day. Because of this, the threshold for adaptive remodeling processes in the
condyle will not be attained.
• When the Herbst appliance is used, on the other hand, the mandible is
continuously held in an anterior jumped position 24 hours a day

Treatment results using herbst appliance :
1. Normal occlusal conditions occurred in all patients.
2. Maxillary growth may have been inhibited or redirected. The SNA angle was reduced
slightly.
3. Mandibular growth was greater than average. The SNB angle increased.
4. Mandibular length increased, probably because of condylar growth stimulation.
5. Lower facial height increased. The mandibular plane angle, however, remained
unchanged.
6. The convexity of the soft- and hard-tissue profile was somewhat reduced.

Herbst problems
Mandibular incisor
fracture.
• Rapid intrusion of
mand. PM1
• Repeated breakage
and loosening of PM1
bands occurs.
• Limited to pts wth
erupted PM1 and not
for early corrections
in children. As it
attached to lower
PM1 and M
Depression of lingual bar
Gingival impingement
ulceration
Shortens plungers sleeve combination
Deactivates appliance
To compensate – replacing upper
sleeve

HERBST MODIFICATIONS
• (1982) Herbst staineless steel crowns
• (1982) Bonded herbst appliance
• (1984) Acrylic splint herbst
• (1989) Edgewise bioprogressive herbst
• (1994) Fixed removable herbst appliance
• (1996) Flip lock herbst appliance

Most breakage – lower PM band – softened – soldering
process.
SS crowns on max molar and mand. PM1
Increased ss thickness, occlusal coverage increases
resistance
Herbst staineless steel crowns
( LANGFORD) - 1982

Bonded Herbst appliance
( RAYMOND) - 1982
Advantages
 Instead of PM1 band – entire mand.
Dentition, thereforpts at any stage of
dental development can be fitted with
herbst
 Intrusion of lower premolar avoided as
whole dentition is used as segment
 Prevents mesial migration of incisors
 Tissue impingement avoided as there
is no lingual wire
 Failure due to breakage of band is
eliminated

Edgewise Bioprogressive Herbst
appliance
(TERRY G. DISCHINGER)
1989
• It allows orthodontic tooth movement during
orthopaedic correction
• It permits a smooth transition from herbst
treatment into fixed finishing appliances
Goal : to place edgewise wire as quickly as
possibly to maintain torque of max incisors
while class 2 is being corrected

• 36, 46 banded
• Upper full arch bonding, Lower only incisors bracketed
• 0.040 lingual wire joins the mand. Crowns and bands
• No transpalatal arch in maxilla - to facilitate rotation of
maxillary crowns during class 2 to class 1 shift
• Double buccal tube on max. molar crown serve as arch
wire slot, extra tube is used to hold archwire that
intrudes max. incisors
• Aw is tied back to hook on each upper molar tube to
prevent space opening b/w pm2 and m1
• Mandible - .022 x .028 slot on each ss crown
accommodates aw
• Bioprogressive Sectional mechanics used in LA until
utility arch can be placed through incisors into slots on
ss crowns

Advantages
 Orthopaedic + Orthodontic at sametime
 Proper maxillary incisor torque and arch
alignment achieved
 Mandibular arch is leveled and overbite is
corrected
 Dumping of LI cuz of herbst app is avoided by
using a lower utility arch
 Stability enhanced – by levelling lower arch, and
thus eliminating any anterior tooth contact upon
removal of app.
Disadvantages
X Fitting - placing – removing
X Relatively costly cuz of skill required to
construct it

• Ss crowns = Instead of 16, 26  55,
65
Instead of 34, 44 / 33, 43 74, 84
• If any teeth exfoliates – pause the
treatment until permanent teeth erupts
to attach ss crown on it
 Treatment competes within 12- 18
months
 As skeletal problem and abnormal
muscle function is modified, Lower
crowding is spontaneously corrected
and remain stable
 Effect is rapid and predictable
Indicated only if malocclusion is severe if not wait till
permanent teeth erupts and carry on

EMDEN H A
(TAREK ZREIK)
1994
 It requires minimal cooperation.
 It allows more cases to be treated without
extractions.
 It is easy to construct, fit, adjust, and
clean.
 Materials are inexpensive, and breakage
is minimal
 The lower splint increases anchorage and
restricts forward movement of LI.

• .039 x .079 wire – bend into framework
on lower model for acrylic splint
• Solder herbst plungers to framework
between cuspids and pm1
• Cold cure acrylic – base of acrylic splint
• Vacuum press a 2-3mm biocryl sheet
over model

 Reactivation - 2mm every six
weeks.
 Average treatment time was
six months,
 Mean overjet reduction was
5.2mm
 Mean molar correction was
6.5mm

FLIP-LOCK HERBST APPLIANCE
• A new design, reduces the number of
moving parts that can lead to breakage or
failure.
• It is easy to use and more comfortable for
the patient than the conventional Herbst.
• Instead of a screw attachment, it has a ball-
joint connector, and it needs no retaining
springs.
FLIP LOCK
(ROBERT A MILLER)
1996

• The first generation was made from a dense
polysulfone plastic but breakage occurred
because of the forces generated within the
ball-joint attachment

• In the second generation, the plastic
was replaced with metal

• The third generation is made of a horse-
shoe ball joint .
• This system has proved to be more efficient
than the previous models, both in terms of
application as well as its resistance to
fracture

ADVANTAGES
Improved pt compfort and
acceptance
Fewer clinical problems compared to
screw or pin attachments
Less chair time for activation
Less frequent emergency
appointments

End of rod is crimped onto mandibular ball.
Advantages :
Less irritation
reduces the number of moving parts that
can lead to breakage or failure

Mand Protraction App
(carlos martins coelho)
1991,1998,2001

 They are easily fabricated at chairside with ordinary, inexpensive
wires.
 Do not require any special bands, crowns, or wire attachments.
 No impressions or wax bite registrations are used, and no laboratory
assistance is needed.
 Easily inserted, adjusted, and removed.
 Can be made and installed in about 30 minutes.
 They are much smaller and thus more comfortable and acceptable to
patients than other appliances.
 They permit a greater range of motion and are less restrictive of
movement than other

• Two maxillary tubes of .045" internal diameter, each about
27mm long
• Two maxillary loops of .040" stainless steel wire, each about
13mm long, with a loop bent into one end at an angle of about
130° to the horizontal
• Two mandibular rods of .036" stainless steel wire, each about
27mm long
• Four pieces of band material
• Two short lengths of annealed .036" stainless steel wire, each
with a loop in one end, for attaching the appliance to the
maxillary molar headgear tube
MPA III

MPA IV
“
“T” tube ; Upper molar locking pin ; Mandibular rod ; Mandibular
archwire

The amount of activation will be determined by the number of turns in the coil

 The Mandibular Protraction Appliance has proven to be
effective during approximately 10 years of clinical use.
 This fourth version seems to be as efficient as its antecedents,
but is much more practical to construct,
 easy to manipulate, and
 comfortable for the patient

• The Intraoral Snoring-Therapy Appliance is a
fresh device to treat patient suffering from
inhalation problems during sleep, e.g.
obstructive sleep apnea.
• According to the creator, the IST appliance
overturns snoring by moving the mandible
forward that reduce the obstruction in the
pharyngeal area. T
IST (INTRA ORAL SNORING
THERAPY) APP
(Hinz germany)

The device offers two very important advantages:
• The telescope is attached so the operator can change
the protrusion on each side separately up to 8mm.
• An end stop in the guiding sleeve prevents the telescope
from disengaging.
• The appliance is available in two more lengths..

• Mandibular advancing repositioning splint.
• The MARS appliance is composed of a pair of
telescopic struts, the ends of which are attached to
the upper and lower archwires of a multi-banded
fixed appliance by means of locking device.
MARS APPLIANCE
(Ralph Clements and Alex Jacobson)
- 1982

• Alignment must be complete. prior to attachment of the
appliance.
• The MARS appliance should be attached only to the heaviest
rectangular arch wires that can be accommodated by the
brackets and tubes.
• The heavy arch wire prevents breakage at the point of
attachment as well as excessive intrusion in the region of the
mandibular canines.
• The mandibular arch wires should be securely tied back to the
terminal molar before attachment of the MARS appliance.

Herbert appliance vs the MARS
appliance :
Requires neither soldering nor extensive lab procedures.
Has minimal incidence of breakage
Does not depress the canines, open spaces in the premolar area or
flare mandibular incisors (provided the mandibular rectangular
archwire is tied back to the terminal molars)
Is easily removed.

• The Ritto Appliance can be described as a
miniaturized telescopic device with
simplified intraoral application and
activation
• It is a single piece device with telescopic
action. It is used on both side due to its
Jingle format.
• Total length of appliance when closed is
25mm and at maximum opening is 33mm.
RITTO APPLAINCE
(RITTO A. K- 1998)

• Fixation accessories consist of a steel ball pin
and a lock.
• Upper fixation is carried out by placing a steel
ball pin from the distal into the .045 headgear
tube on the upper molar band, through the
appliance eyelet and then bending it back on
the mesial end.

• The appliance is fixed onto a prepared lower
arch and is activated by sliding the lock along
the lower arch in the distal direction and then
fixing it against the Ritto Appliance.

• It consists of buccal attachments soldered to maxillary
and mandibular molar crowns.
• The attachments contain a standard edgewise tube and
a large 0.070 inch molar tube. Large rods pass through
these tubes.
• The mandibular rod inserts from the mesial of the
molar tube and is fixed at the distal by a screw clamp.
By moving the rod mesially the appliance is activated.
BIOPEDIC APPLIANCE
(Jay Collins in 1997 GAC Internationa)

• This short maxillary rod is inserted screw at the mesial of the maxillary first molar.
• The two rods are connected by a rigid shaft and have pivotal region at their ends.
• Although, it appears that there would be limitation of mandibular opening, it is not
so. The design works more in harmony with the arc of mandibular opening.

FLEXIBLE FIXED FUNCTIONAL
APPLIANCES

Rigid FFA Hybrid FFA
Flexible FFA
• Herbst its modifications
• MARA
• MARS
• IST
• Biopedic appliance
• Ritto app
• Magnetic Telescopeic
Device
• UBJ
• Jasper jumper
• Amoric torsion coils
• Adustable bite
corrector
• Klapper super spring
• Churro jumper
• Scandee tubular
jumper
• Eureka spring
• Forsus
• Twin force bite
corrector
• Alpern class II closer
Classification by Ritto korrodi (2001)

• This interarch flexible force
module allows patient
greater freedom of
mandibular movement than
is possible with the original
bite jumping mechanism of
Herbst.
JASPER JUMPER
(Dr. James Jasper)
1987
JAMES JASPER; MC. NAMARA., Corrections of interarch malocclusions using a fixed force, module, AJODO 1995

2 PARTS – FORCE MODULE; ANCHOR UNITS
FORCE MODULE :
• The force module, analogous to the tube and plunger of
the Herbst bite – jumping mechanism and is flexible.
• Constructed of stainless steel coil of spring attached at
both ends to stainless steel end caps in which holes
have been drilled in the flanges to accommodate the
anchoring unit.
• This module is surrounded by an opaque poly urethane
covering for hygiene and comfort.

• The modules are available in seven lengths
ranging from 26 to 38 mm in 2 mm
increments.
• They are designed for use on either side of
the dental arch.

• When the force module is straight, it remains passive.
• As the teeth come into occlusion, the spring of the force module is curved axially
as the muscles of mastication elevate the mandible, producing a range of forces
from 1 to 16 ounces

1. Attachment to the main arch wire
• When the jumper mechanism is used to correct
a class II malocclusion, the force module is
attached Posteriorly to the maxillary arch by a
ball pin placed through the distal attachment
of the force module.
• The module is anchored anteriorly to the lower
arch wire (0.018”x 0.025” or 0.0x0.025” ).
ANCHORING UNIT :

• Bayonet bends are placed distal to the
mandibular canines and a small Lexan ball is
slipped over the archwire to provide an anterior
stop.
• The mandibular archwire is threaded through
the hole in the anterior end cap and then ligated
in place.
• The first and second bicuspid brackets are
removed to allow the patient greater freedom of
movement.

2. Attachment to auxiliary arch wires :

EFFCTS:
• 40% - skeletal; 60% - dental acc. to Rankin, and Parker

Skeletal changes
 The increase in mandibular length - due to condylar growth stimulation as an adaptive
reaction to the forward positioning of the mandible -> clockwise rotation of mandible.
 The gonion angle increased slightly. (This may be due to a more sagittally directed
growth of the condyle or it may result from resorptive bone changes in the gonion
region, probably as a consequence of an altered muscle function during bite jumping).
 Stimulating effect on mandibular growth + restraining effect on maxillary growth

Dental changes
 Posterior tipping and intrusion of upper molars;
 Backward tipping of maxillary incisors;
 Anterior translation and tipping of mandibular teeth;
 Intrusion of mandibular incisors

Jasper’s theory of two’s”
Suggests that class II correction with Jasper jumper therapy can be equally
proportioned between 5 components.
20% due to maxillary basal restraint
20% due to backward maxillary dento alveolar movement
20% due to forward mandibular dentoalveolar movement
20% due to condylar growth stimulation
20% due to downward / forward glenoid fossa remodeling

It is flexible.
The jaws can open fully.
Force is directed distal to the molar; if the archwire breaks there is no
effect on the anterior teeth.
The jumper does not interfere with space closure or leveling procedures.
No auxiliary tubes are needed on the mandibular molars.
Advantges

× Unattached bicuspids tend to erupt above
the occlusal plane as the anterior teeth are
intruded.
× When only the lower 1st bicuspid bracket
used to be removed as originally suggested
by Dr. Jasper, Jaw opening used to be limited
as the lower portion of the jumper tends to
bind at the 2nd bicuspid.
Disadvantages

X Replacement of a broken jumper required removal of the
entire archwire.
X Removing the Jumper is time consuming
X If an arch breaks or comes untied at the distal tieback, all the
force is transferred to the anterior teeth, which tends to tip
them forward depress them and open space.
JAMES JASPER; MC. NAMARA., Corrections of interarch malocclusions using a fixed force, module,
AJODO 1995

• Bilateral appliance
• 2 intermaxillary springs
• One inside the other
• Have rings on the ends through which
it is attached using double ligatures
• Amount of force exerted is prop. To
fixing points on the arch
• Marketed in one size only
AMORIC TORSION COILS
(Amoric. N)
1994
AMORIC M. Les Ressorts intermaxillaries en torsion. Rv. Orthop. Dento Facial 1994; 28:
115-117

The appliance essentially consists of:
• A stretchable closed coil spring and internally
threaded end cap
• nickel titanium wire in the centre lumen of the spring.
• The closed coil spring is made of 0.018” stainless
steel, and will stretch to about 25% beyond its original
length without permanent deformation.
ADJUSTABLE BITE CORRECTOR
(Richard P. West)
1995
Journal of Cinical Orthodontics 1995; 29, 650-657

• The ABC can be used on either side of the
mouth with a simple 180 rotation of the lower
end cap to change it orientation.
• Functions similar to the Herbst and Jasper
Jumper but also incorporates several useful
features like
a) Universal right and left
b) Adjustable length and force

• After the patient has postured forward into an
improved profile with ideal overbite / overjet the
point of the gauge is placed into the mesial opening
of the headgear tube.
• The size is then read at point about 3mm below the
contact between lower cuspid and first premolar
using the correct appliance size ensuring optimum
force delivery.

• The ABC can be lengthened as much as 4mm, or two and a half turns at each
end.
• Going beyond this will cause the spring to pull out of the end cap when the patient
opens wide and pulls on the spring.
• These adjustable feature can be used for treatment of asymmetrical problems or
midline shifts

• It resembles a Jasper Jumper with a substitution of a cable for the
coil spring.
• In 1998 the cable was wrapped with a coil and the Klapper
superspring II was the result.
• Only two sizes are required (left and right sides are not
interchangeable) and breakage is less frequent.
• However it differs significantly from the Jasper Jumper at the
molar attachment.
The Klapper Superspring II
(Lewis Klapper in 1997)
THE super spring ii a new appliance for non – compliant class II patients, JCO 1999;33:50-54

• The SUPERspring II is a flexible spring element that attaches between the maxillary molar and the
mandibular canine.
• It is designed to rest in the vestibule, making it impervious to occlusal damage and allowing for good
hygiene.
• Only minor adjustments are needed for patient comfort, without any impingement on soft tissues.

• Useful in variety of class II cases from hyperdivergent to brachyfacial patterns with
shallow and deep overbites
• Commonly used with fixed mechanotherapy
• The SUPERspring II has eliminated nearly all Class II compliance problems –
• without premature debonding, and
• with cases finished to a satisfactory standard

CHURRO JUMPER
(RICARDO CASTAÑON, MARIO S.
VALDES, LARRY W. WHITE) - 1998

• It is made of a series of 15-20 symmetrical and closely placed circles are formed
in a wire. The wire size can be .028" to .032“

The length of the jumper is determined by the
distance from the distal of the mandibular
canine bracket to the mesial of the headgear
tube on the maxillary molar band, plus 10-
12mm.
This measurement is transferred to the Churro
Jumper, with the coil closer to the canine
bracket than to the headgear tube.

• A circle is then formed at each
termination mark on the Churro wire, so
that the coils of the jumper lie against the
cheek and the terminal circles face the
teeth.
• The maxillary circle is completely closed,
but the mandibular circle is only partially
closed to allow its placement over the
mandibular archwire and subsequent
closure.

• A pin made of .036" wire is used to secure the maxillary circle through the distal of
the headgear tube.
• The maxillary pin is pulled mesially through the headgear tube until the jumper
has a slight buccal bow in it, and is then turned down (Fig. 9). Initially, the pin is
not cinched tightly against the tube, which improves patient comfort and allows
space for later adjustments.
• At subsequent appointments, as the teeth move and adjust to the forces of the
Churro Jumper, the headgear pin is pulled forward to reactivate it.

• The mesial end of the Churro Jumper is an open circle that is placed over the
mandibular archwire, against the canine bracket.
• In its passive form, the Churro Jumper is not flexed. However, when the pin is
pulled forward enough to cause the jumper to bow outward toward the cheek,
• the appliance exerts a distal and intrusive force against the maxillary molar and a
forward and intrusive force against the mandibular incisors as it attempts to
straighten

 This jumper can be used unilaterally in cases of class II
subdivision malocclusions.
 The bilateral class II churro jumper is most suitable for
patients who need mandibular incisors advancement.
 By reversing the attachments, the churro jumper can also
be used to treat class III malocclusions.
 It is universal in size and can be adapted to fit any
malocclusion.
 When broken, it is easily and inexpensively removed and
replaced.

DISADVANTAGES
• Not a very good choice for class II bimaxillary proclination cases.
• The restriction of mouth opening to 30-40mm is intolerable for some patients.
• Archwire breakage is common if larger wires are not used.

Scandee tubular jumper
(Scandee , norway) - 1999
• Highly coated intermaxillary torsion spring
• Kit consists of spring, connectors, ball pins,
coverings
• Right and left sides cannot e differentiated
• Different colors of coverings available
• When fracture occurs it is only necessary to
replace individual components
• Drawback: it is thick after covering is palced

HYBRID FIXED FUNCTIONAL
APPLIANCES

• Rigid fixed appliances – restrict mandibular movement
• Flexible fixed appliances – greater chance of breakage
• To overcome these drawbacks hybrid fixed functional appliances

EUREKA SPRING
(Dr. DeVincenzo)
1997
Fore runner to EUREKA
SPRING was a system
deviced by Northcutt in
1974
Northcutt device (1974)
• A pair of spring arrangements are provided
to assist the patient in moving his upper row
of teeth rearward), and his [lower row of
teeth forwardly each time he closes his
mouth, utilizing the vertical closure force of
his masseter muscle converted into
horizontal corrective vectors
• The vertical closure force of the masseter
muscle is about 25,000 pounds per square
inch, and the present invention converts this
huge force into horizontal corrective vectors

• Changes to Northcutt’s design,
 Including triple telescoping action,
 Flexible ball-and-socket attachments,
 Completely encased spring that
remains intact even if the device
becomes disengaged,
 Shaft for guiding the spring
• The main component of the Eureka Spring
is an open-wound coil spring encased in a
plunger assembly
EUREKA SPRING
(Dr. DeVincenzo)
1997

most important characteristics of an ideal system are as follows (in decreasing
order of importance)
• Ability to function without the need for patient cooperation. Cooperation is essential
with Class II elastics, and some cooperation is required with Saif and Sentalloy
springs, since the patient must remember to avoid breakage by not opening the mouth
too wide. Minimal cooperation is required with the Eureka Spring, Jasper Jumper, and
fixed Herbst.
• Esthetic acceptability to patients. Eureka Spring, is almost invisible because of its
small size and lack of protuberances into the buccal vestibule.

• Resistance to breakage. Other appliances break far too often; breakage of
elastics discourages patient cooperation and probably prolongs treatment
time.
• Forces in the range of 220-280g can be measured at the points of attachment
in closure of the Jasper Jumper
• The Eureka Spring produces forces of only 140-170g at the points of
attachment, reducing the possibility of breakage.

• It never functions in any mode other than straight compression, which is
evenly distributed over the entire length of the spring.
• Wave motion normally would develop within the spring as compression
increases, but is prevented by the guiding shaft on the inside and the cylinder
on the outside.
• These factors, along with the use of low-fatigue material, have produced a
spring life of three to six months

• Eureka Spring continues to work even when the mouth is opened as much as
20mm, as when sleeping, or when the mandible is thrust forward as far as 10mm
in an attempt to minimize the force.
• The Jasper Jumper applies no force in these two positions. In addition, frequent
breakage of the Jasper Jumper result in a wide range of correction rates.

• Designed to substitute the elastics
• Telescopic device with an inner coil spring and hooks for
fixing.
• Fixed to mandibular molar and to maxillary cuspid
Alpern class II corrector
(GAC International Inc)

• This is an interarch push spring which
produces about 200g of force when fully
compressed.
• The distal end of the FRD`s push rod inserts
into the telescopic cylinder and a hook on
the mesial end is crimped directly to the
archwire near the canine or premolar
brackets.
Forsus : Fatigue resistant Device
(William vogt – 2006 3M UNITEK)

• The push rod has a built in stop that compresses the
spring when the patients mouth closes. The spring is
then transferred to the maxillary molars using the
mandibular arch as the anchorage unit.
• The L-pin is inserted in the eyelet of the telescoping
spring and is threaded through the molar headgear
tube from distal to mesial and cinhed, leaving 2mm
slack.
• The mesial hook is looped over the mandibular arch
wire and crimped shut.

• The appliance’s flat surface is more
esthetically acceptable and it offers more
comfort.
• The Forsus Nitinol Flat Spring is slim, flat and
made of Super-Elastic Nitinol.
• Force levels remain constant from the initial
setup to the time of removal.
• The result is faster, more efficient treatment.

`
• Heinig N, Goz G 2001 reported the use of Forsus spring over a period of 4 months to
treat 13 patients with an average age of 14.2 years with Class II malocclusion.
• RESULTS: lateral cephalograms showed that dental effects accounted for 66% of the
sagittal correction.
• The sagittal occlusal relations were improved by approximately 3/4 of a cusp width to
the mesial on both the right and left side as a result of distal movement of the upper
molars and mesial movement of the lower molars.
• Retrusion of the upper and protrusion of the lower incisors reduced the overjet by 4.6
mm. Intrusion and protrusion of the lower incisors reduced the overbite by 1.2 mm.

• The occlusal plane was rotated by 4.2 degrees in clockwise direction as a result of
intruding the lower incisors and the upper molars. The maxillary and mandibular arches
were expanded at the front and rear during treatment.
• The main problem, however, was the restriction experienced in the ability to yawn.
Overall, two thirds of the adolescents found the Forsus spring better than the appliance
previously used to correct their Class II malocclusion, such as headgear, activator or Class
II elastics.
• CONCLUSION: The Forsus spring has stood the test in clinical application. It is a good
supplement to the Class II appliance systems already available.

• This appliance differs from others in form and constitution
because it has two internal coil springs. It consists of two
joint telescopic systems.
• At the superior level it is fixed with a ball pin that is fitted
into the buccal tube of a molar band.
• The placement in the lower arch is slightly different; it
involves a fitting-in system that is later fixed with a screw
to the inferior arch. Normally it is placed distal to the lower
cuspid.
TWIN FORCE BITE
CORRECTOR

• Powerscope provides best non extraction option for class II situations
due to functional retrusion of mandible in non compliant pts
• Indicated for both growing and non growing patients
• Pts with average axial inclination of upper and lower incisors
• Contraindicated in pts with nickel allergy , compromised periodontal
condition or absence of complete permanent dentition
Power Scope (Dr. Andy Hayes)

PARTS
• Locking nut attachment
• Telescopic system
• Niti spring
• Head screws
• Crimpable shims
• Hex head driver
• Driver magnets

Contra Indications
• Nickel allergy
• Vertical growth pattern
• Compromised dentition
• Periodontal problems
Indications
• Class II correction with dentoalveolar
compensation
• Class II div 1 and 2 cases
• Unilateral class II correctins
• Asymmetric midline corrections

CONCLUSION :
• Fixed functional appliances form an useful addition to the clinician’s orthodontic
armamentarium.
• But many of these appliances need further studies to substantiate the claims made by
their respective originators.
• With this in mind, clinicians must take great care in selecting the right patient and also
pay attention to every detail in the manipulation, to attain successful results with these
appliances.

TITLE LOREM IPSUM DOLOR
2017
Lorem ipsum dolor sit amet
2018
2019

fixed functional appliances

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