Copy of 21

Recent advancements inRecent advancements in
fixed functionalfixed functional
appliancesappliances
www.indiandentalacademy.comwww.indiandentalacademy.com

The past is a source of knowledge, and theThe past is a source of knowledge, and the
future is a source of hope. To love the pastfuture is a source of hope. To love the past
implies a faith in the future.implies a faith in the future.

A Functional appliance byA Functional appliance by
definition is one that changes thedefinition is one that changes the
posture of the mandible, holdingposture of the mandible, holding
it open or open and forward.it open or open and forward.
Pressures created by the stretchPressures created by the stretch
of the muscles and soft tissuesof the muscles and soft tissues
are transmitted to the dentalare transmitted to the dental
and skeletal structures ,movingand skeletal structures ,moving
teeth and modifying growthteeth and modifying growth

CLASSIFICATIONCLASSIFICATION
Functional appliances can be classified asFunctional appliances can be classified as
REMOVABLE FUNCTIONAL APPLIANCESREMOVABLE FUNCTIONAL APPLIANCES
FIXED FUNCTIONAL APPLAIANCESFIXED FUNCTIONAL APPLAIANCES

Removable functional appliances are normallyRemovable functional appliances are normally
very large in size, have unstable fixation, causevery large in size, have unstable fixation, cause
discomfort, lack tactile sensibility, exert pressurediscomfort, lack tactile sensibility, exert pressure
on the mucous (encouraging gingivitis), reduceon the mucous (encouraging gingivitis), reduce
space for the tongue, cause difficulties inspace for the tongue, cause difficulties in
deglutition and speech and very often affectdeglutition and speech and very often affect
aesthetic appearance. The alteration in theaesthetic appearance. The alteration in the
mandibular posture creates added difficulties.mandibular posture creates added difficulties.
These adverse effects make the adaptation andThese adverse effects make the adaptation and
acceptance of these appliances more difficult.acceptance of these appliances more difficult.

Fixed functional systems have some advantagesFixed functional systems have some advantages
over removable systems. They are designed to beover removable systems. They are designed to be
used 24 hours a day, which means that there is aused 24 hours a day, which means that there is a
continuous stimulus for mandibular growth.continuous stimulus for mandibular growth.
They are smaller in size permitting betterThey are smaller in size permitting better
adaptation to functions such as a mastication,adaptation to functions such as a mastication,
swallowing, speech and breathing.swallowing, speech and breathing.
Fixed functional appliances are usually describedFixed functional appliances are usually described
as non-compliance Class II devices, which areas non-compliance Class II devices, which are
able to treat Class II malocclusions successfully,able to treat Class II malocclusions successfully,
while reducing the need for patient co-operationwhile reducing the need for patient co-operation
and overall treatment time. It is possible to treatand overall treatment time. It is possible to treat
this type of malocclusion with minimal effort.this type of malocclusion with minimal effort.

Fixed functional appliances are normally knownFixed functional appliances are normally known
as "non-compliance Class II correctors" giving aas "non-compliance Class II correctors" giving a
false idea about the co-operation necessaryfalse idea about the co-operation necessary
during treatment. In reality, when we compareduring treatment. In reality, when we compare
them to removable appliances, we can clearlythem to removable appliances, we can clearly
recognize fixed appliances as non-compliancerecognize fixed appliances as non-compliance
devices. However, for treatment to bedevices. However, for treatment to be
successful, good co-operation is alwayssuccessful, good co-operation is always
necessary, especially if skeletal modificationsnecessary, especially if skeletal modifications
instead of dento alveolar compensation areinstead of dento alveolar compensation are
desired.desired.

Functional-appliance therapy can achieve correctionFunctional-appliance therapy can achieve correction
of Class II malocclusion through the followingof Class II malocclusion through the following
factors:factors:
Dentoalveolar changesDentoalveolar changes
Restriction of forward growth of the mid faceRestriction of forward growth of the mid face
Stimulation of mandibular growth beyond that whichStimulation of mandibular growth beyond that which
would normally occur in growing children,would normally occur in growing children,
Redirection of condylar growth from an upward andRedirection of condylar growth from an upward and
forward–directed growth to a posterior directionforward–directed growth to a posterior direction
Deflection of ramal form,Deflection of ramal form,
Horizontal expression of mandibular growth fromHorizontal expression of mandibular growth from
downward and forward to horizontal.downward and forward to horizontal.
Changes in neuromuscular anatomy and functionChanges in neuromuscular anatomy and function
that would induce bone remodeling,that would induce bone remodeling,
Adaptive changes in glenoid fossa location to aAdaptive changes in glenoid fossa location to a
more anterior and vertical position.more anterior and vertical position.

Mode of action of functionalMode of action of functional
applianceappliance
Regardless of various functional appliances, theRegardless of various functional appliances, the
following casual chain is involvedfollowing casual chain is involved
Functional applianceFunctional appliance
Increased contractile activity of LPMIncreased contractile activity of LPM
Intensification of the repetitive activity of theIntensification of the repetitive activity of the
retrodiscal pad (bilaminar zone)retrodiscal pad (bilaminar zone)

Increase in growth stimulating factorsIncrease in growth stimulating factors
Enhancement of local mediatorsEnhancement of local mediators
Reduction of local regulators (factors havingReduction of local regulators (factors having
negative feed back effects on cell multiplicationnegative feed back effects on cell multiplication
raterate
Change in condylar trabecular orientationChange in condylar trabecular orientation
Additional growth of the condylar cartilageAdditional growth of the condylar cartilage
Additional sub periosteal ossification of theAdditional sub periosteal ossification of the
posterior border of the mandibleposterior border of the mandible
Supplementary lengthening of the mandibleSupplementary lengthening of the mandible

One step versus stepwise advancementOne step versus stepwise advancement
using fixed functional appliancesusing fixed functional appliances
Rabie et al’s work on experimental rats showedRabie et al’s work on experimental rats showed
that during the first advancement ,bone formationthat during the first advancement ,bone formation
in the condyle and the glenoid fossa was less thanin the condyle and the glenoid fossa was less than
that of the 1 step advancement .In response to thethat of the 1 step advancement .In response to the
second advancement ,new bone formation in thesecond advancement ,new bone formation in the
condyle and the glenoid fossa was significantlycondyle and the glenoid fossa was significantly
greater when compared with single advancementgreater when compared with single advancement
with a maximum increase of 50% and 100%with a maximum increase of 50% and 100%
respectively. Moreover the higher level of bonerespectively. Moreover the higher level of bone
formation in the stepwise advancement isformation in the stepwise advancement is
maintainedmaintained

The results of the present study alsoThe results of the present study also
indicate that the stepwise advancementindicate that the stepwise advancement
produces a much more prominent effect onproduces a much more prominent effect on
the growth of the glenoid fossa whenthe growth of the glenoid fossa when
compared with the condyle. The amount ofcompared with the condyle. The amount of
increase in bone formation in the glenoidincrease in bone formation in the glenoid
fossa in response to stepwise advancementfossa in response to stepwise advancement
when compared with single advancementwhen compared with single advancement
was 2 times more than that expressed in thewas 2 times more than that expressed in the
condyle.condyle.

An explanation of these results could relateAn explanation of these results could relate
to the age of the animals used as reportedto the age of the animals used as reported
by Woodside and coworkers they showedby Woodside and coworkers they showed
that in older primates there was a morethat in older primates there was a more
pronounced response in the glenoid fossapronounced response in the glenoid fossa
than the condyle in mandibularthan the condyle in mandibular
advancement, whereas in the youngeradvancement, whereas in the younger
primates there was a more pronouncedprimates there was a more pronounced
response in the condyle. Additionalresponse in the condyle. Additional
explanation of the enhanced response of theexplanation of the enhanced response of the
glenoid fossa was found to be caused by theglenoid fossa was found to be caused by the
amount of the blood vessels recruited in theamount of the blood vessels recruited in the
glenoid fossa in response to advancement."glenoid fossa in response to advancement."

Recently, Rabie et al reported thatRecently, Rabie et al reported that
mechanical strain caused by forwardmechanical strain caused by forward
mandibular positioning stimulated the cells ofmandibular positioning stimulated the cells of
the chondroid layer in the glenoid fossa tothe chondroid layer in the glenoid fossa to
secrete vascular endothelial growth factorsecrete vascular endothelial growth factor
(VEGF), which was 220% more than its(VEGF), which was 220% more than its
levels during natural growth." VEGFlevels during natural growth." VEGF
enhances the invasion of new blood vesselsenhances the invasion of new blood vessels
and the perivascular connective tissuesand the perivascular connective tissues
surrounding these new blood vessels aresurrounding these new blood vessels are
repository sites of mesenchymal cells. Theserepository sites of mesenchymal cells. These
cells could in turn replenish the populationcells could in turn replenish the population
size of osteoprogenitor mesenchymal cells.size of osteoprogenitor mesenchymal cells.

VEGF also stimulates the vascular endothelial cellsVEGF also stimulates the vascular endothelial cells
to secrete growth factors and cytokines thatto secrete growth factors and cytokines that
influence the differentiation of mesenchymal cellsinfluence the differentiation of mesenchymal cells
to enter the osteogenic pathway and engage into enter the osteogenic pathway and engage in
bone synthesis."'bone synthesis."'
On the other hand, the amount of VEGFOn the other hand, the amount of VEGF
expressed in the condyle in response to mandibularexpressed in the condyle in response to mandibular
advancement was only 48% more than naturaladvancement was only 48% more than natural
growth. Therefore, it is conceivable that thegrowth. Therefore, it is conceivable that the
significant difference in the response between thesignificant difference in the response between the
glenoid fossa and the condyle is because of theglenoid fossa and the condyle is because of the
ability of both tissues to vascularize to a differentability of both tissues to vascularize to a different
degree in response to advancementdegree in response to advancement

The ideal period for therapyThe ideal period for therapy
With respect to the maximum mandibularWith respect to the maximum mandibular
growth stimulation and long term stabilitygrowth stimulation and long term stability
of the treatment, the ideal period is in theof the treatment, the ideal period is in the
permanent dentition at or just after thepermanent dentition at or just after the
pubertal peak of growth corresponding topubertal peak of growth corresponding to
the skeletal maturity stages FG to H of thethe skeletal maturity stages FG to H of the
MP3 (implying to the pre capping and preMP3 (implying to the pre capping and pre
union stages of the epiphysis andunion stages of the epiphysis and
metaphysis)metaphysis)

Fixed functional appliances can be classifiedFixed functional appliances can be classified
as eitheras either
Flexible (Flexible Fixed FunctionalFlexible (Flexible Fixed Functional
Appliance - FFFA)Appliance - FFFA)
Rigid (Rigid Fixed Functional Appliance -Rigid (Rigid Fixed Functional Appliance -
RFFA).RFFA).
Hybrid appliancesHybrid appliances

Flexible fixed functional appliances (FFFA)Flexible fixed functional appliances (FFFA)
can be described as an inter-maxillarycan be described as an inter-maxillary
torsion coils, or fixed springs. Elasticitytorsion coils, or fixed springs. Elasticity
and flexibility are the main characteristicsand flexibility are the main characteristics
of flexible appliances. They allow greatof flexible appliances. They allow great
freedom of movement of the mandible.freedom of movement of the mandible.
Lateral movements can be carried out withLateral movements can be carried out with
ease.ease.

Draw backs are the propensity with which fracturesDraw backs are the propensity with which fractures
can occur both in the appliance itself (mainly incan occur both in the appliance itself (mainly in
areas that have more acute angles) and in theareas that have more acute angles) and in the
support system (mainly in the lower arch). Thesupport system (mainly in the lower arch). The
appliance tend to produce fatigue in the springs.appliance tend to produce fatigue in the springs.
Another drawback is the tendency of the patient toAnother drawback is the tendency of the patient to
chew on the appliance, possibly contributing tochew on the appliance, possibly contributing to
breakage or damage. While it is not possible for thebreakage or damage. While it is not possible for the
patient to completely open his mouth, depending onpatient to completely open his mouth, depending on
the way the system is fixed onto the lower arch, goodthe way the system is fixed onto the lower arch, good
opening can be achieved.opening can be achieved.
opening the mouths too widely could result inopening the mouths too widely could result in
breakage. Also, they are not very aestheticbreakage. Also, they are not very aesthetic
appliances. When the curvature of the spring isappliances. When the curvature of the spring is
accentuated, some protuberances can appear in theaccentuated, some protuberances can appear in the
cheeks.cheeks. www.indiandentalacademy.comwww.indiandentalacademy.com

These appliances are expensive, therefore, aThese appliances are expensive, therefore, a
system that allows the replacement of some ofsystem that allows the replacement of some of
its components can reduce the cost ofits components can reduce the cost of
treatment. This leads to another disadvantage:treatment. This leads to another disadvantage:
the inventory of material that must be kept.the inventory of material that must be kept.
Almost all are sold in kits of various sizesAlmost all are sold in kits of various sizes
which contain components for both the leftwhich contain components for both the left
and right side. It is not always possible to treatand right side. It is not always possible to treat
a patient with only one size making ita patient with only one size making it
necessary to replace it with a larger size.necessary to replace it with a larger size.
Once again, this increases cost.Once again, this increases cost.

The type of the force exercised by FFFAs isThe type of the force exercised by FFFAs is
continuous and elastic in nature. The amount ofcontinuous and elastic in nature. The amount of
force is variable in accordance with the skeletalforce is variable in accordance with the skeletal
pattern of the patient, the type of movement desiredpattern of the patient, the type of movement desired
and the size of the cusps. Normally, in brachyfacialand the size of the cusps. Normally, in brachyfacial
cases, due to their strong musculature, it iscases, due to their strong musculature, it is
necessary to use more force (greater activation) thannecessary to use more force (greater activation) than
in Dolichofacial cases. The height of the dental cuspsin Dolichofacial cases. The height of the dental cusps
is a factor to bear in mind when treating with FFFAs.is a factor to bear in mind when treating with FFFAs.
If the patient has high cusps with goodIf the patient has high cusps with good
intercuspation, it will be necessary to exert greaterintercuspation, it will be necessary to exert greater
activation on the spring. If the large size of the cuspsactivation on the spring. If the large size of the cusps
is linked to a brachyfacial skeletal pattern with strongis linked to a brachyfacial skeletal pattern with strong
musculature, we can predict a difficult clinicalmusculature, we can predict a difficult clinical
scenario and the appliance will be prone to fracture.scenario and the appliance will be prone to fracture.

If an advance of the mandible is required asIf an advance of the mandible is required as
when treating a retro mandibular case, thewhen treating a retro mandibular case, the
force exerted has to be greater than that usedforce exerted has to be greater than that used
when only dental movement is desired towhen only dental movement is desired to
distalize the upper molar and procline thedistalize the upper molar and procline the
lower incisors. If the goal of the treatment is tolower incisors. If the goal of the treatment is to
achieve dentoalveolar movements, theachieve dentoalveolar movements, the
appliance should be activated minimally byappliance should be activated minimally by
placing a slight bow in the force module. Toplacing a slight bow in the force module. To
maximize the dentoalveolar movements in themaximize the dentoalveolar movements in the
upper arch and minimize any loss ofupper arch and minimize any loss of
anchorage in the lower, the upper arch wire isanchorage in the lower, the upper arch wire is
not tied back.not tied back. www.indiandentalacademy.comwww.indiandentalacademy.com

FFFA produces a "headgear" effect on theFFFA produces a "headgear" effect on the
maxillary dentition due to the intrusive forcemaxillary dentition due to the intrusive force
applied to the maxillary posterior segmentsapplied to the maxillary posterior segments
and produces an anterior intrusive force onand produces an anterior intrusive force on
the lower dentition. It can be used to obtainthe lower dentition. It can be used to obtain
maximum anchorage, holding upper molarsmaximum anchorage, holding upper molars
back as the upper incisors are retractedback as the upper incisors are retracted

Due to the intrusive force on the upper molars, aDue to the intrusive force on the upper molars, a
posterior open bite is common as well as posteriorposterior open bite is common as well as posterior
expansion due to the deflected force module.expansion due to the deflected force module.
Another unwanted common movement is theAnother unwanted common movement is the
tendency for the lower molar to rotate mesiotendency for the lower molar to rotate mesio
buccally, causing a mild posterior cross bitebuccally, causing a mild posterior cross bite
especially when the second molars have not beenespecially when the second molars have not been
banded. Some buccal expansion in the upper andbanded. Some buccal expansion in the upper and
lower arches is to be expected, and placing bandslower arches is to be expected, and placing bands
on the second molars will aid final alignment.on the second molars will aid final alignment.
Placing a transpalatal or lingual arch during thePlacing a transpalatal or lingual arch during the
force activation stage will help control unwantedforce activation stage will help control unwanted
buccal expansion of both arches. Loss of occlusionbuccal expansion of both arches. Loss of occlusion
adds to instability, especially in the transverseadds to instability, especially in the transverse
dimension.dimension.

The most unwanted dental movement is ProclinationThe most unwanted dental movement is Proclination
of lower incisors. To avoid this effect, goodof lower incisors. To avoid this effect, good
anchorage preparation should be carried out.anchorage preparation should be carried out.
However, in a brachyfacial pattern with strongHowever, in a brachyfacial pattern with strong
musculature this movement would be expected. Tomusculature this movement would be expected. To
increase anchorage to avoid unwanted dentalincrease anchorage to avoid unwanted dental
movements, various additional systems can be used,movements, various additional systems can be used,
such as a transpalatal bar, lingual arches or lowersuch as a transpalatal bar, lingual arches or lower
incisor brackets with lingual torque.incisor brackets with lingual torque.
It is advantageous to start the treatment inIt is advantageous to start the treatment in
adolescent patients when the majority of permanentadolescent patients when the majority of permanent
teeth have erupted and 12-year molars can beteeth have erupted and 12-year molars can be
banded. FFFAs are not recommended in mixedbanded. FFFAs are not recommended in mixed
dentition, especially late mixed dentition to avoiddentition, especially late mixed dentition to avoid
unwanted dental movementsunwanted dental movements

Proper anchorage preparation is critical toProper anchorage preparation is critical to
achieving successful results. It is necessary to alignachieving successful results. It is necessary to align
and level arches before placing the final wire andand level arches before placing the final wire and
activating the force module. A .017" x .025" or .018"activating the force module. A .017" x .025" or .018"
x .025 stainless steel arch wire should be placedx .025 stainless steel arch wire should be placed
before inserting the FFFA. By fully engaging thebefore inserting the FFFA. By fully engaging the
brackets in both arches, especially the lower,brackets in both arches, especially the lower,
anchorage is maintained during the activation of theanchorage is maintained during the activation of the
force module, preventing unwanted mesialforce module, preventing unwanted mesial
movement of the lower incisors and distalmovement of the lower incisors and distal
movement of the uppers. When proclining the lowermovement of the uppers. When proclining the lower
incisors is desired as in Class II division 2 it may beincisors is desired as in Class II division 2 it may be
advantageous to use a .016" x .022" stainless steeladvantageous to use a .016" x .022" stainless steel
arch wire as a final wire.arch wire as a final wire.www.indiandentalacademy.comwww.indiandentalacademy.com

All FFFAs allow the patient to close in centricAll FFFAs allow the patient to close in centric
relation.relation.
When the patient closes in centric relation,When the patient closes in centric relation,
the contour of the bow should be significantlythe contour of the bow should be significantly
increased. By slightly over activating theincreased. By slightly over activating the
appliance in centric relation, the patient willappliance in centric relation, the patient will
automatically position the mandible forward.automatically position the mandible forward.
This is a natural response to decrease theThis is a natural response to decrease the
force module and alleviate discomfort. Theforce module and alleviate discomfort. The
upper arch wire should be cinched toupper arch wire should be cinched to
increase anchorage and minimizeincrease anchorage and minimize
dentoalveolar movements.dentoalveolar movements.www.indiandentalacademy.comwww.indiandentalacademy.com

JASPER JUMPERJASPER JUMPER
It is the most successful and widely usedIt is the most successful and widely used
inter arch force delivery system.inter arch force delivery system.
This inter arch appliance uses a pushThis inter arch appliance uses a push
force than a pull force.force than a pull force.
It is made up of a covered spring and isIt is made up of a covered spring and is
marketed in a kit of different sizes withmarketed in a kit of different sizes with
both left and right sidesboth left and right sides

INDICATIONS:INDICATIONS:
Dental class II malocclusionDental class II malocclusion
Skeletal class II with maxillary excess as opposed toSkeletal class II with maxillary excess as opposed to
mandibular deficiencymandibular deficiency
Deep bite with retroclined mandibular incisorsDeep bite with retroclined mandibular incisors
CONTRA INDICATIONS:CONTRA INDICATIONS:
Cases predisposed to root resorptionCases predisposed to root resorption
Dental and skeletal open bitesDental and skeletal open bites
Vertical growth with high mandibular plane angle andVertical growth with high mandibular plane angle and
excess lower facial heightexcess lower facial height
Minimum buccal vestibular spaceMinimum buccal vestibular space

Advantages of jasper jumper are its easeAdvantages of jasper jumper are its ease
of insertion and activation and generationof insertion and activation and generation
of the intrusive forces on molars andof the intrusive forces on molars and
incisors where as disadvantages includeincisors where as disadvantages include
large inventory five sizes of left and right ,large inventory five sizes of left and right ,
breakage and a lack of force when thebreakage and a lack of force when the
mouth is held open slightly. It is moremouth is held open slightly. It is more
prone for breakage when used to correctprone for breakage when used to correct
class III correctionsclass III corrections

Cope in his study of comparison of Churro jumperCope in his study of comparison of Churro jumper
and jasper jumper found that the Jasper Jumperand jasper jumper found that the Jasper Jumper
consistently:consistently:
Displaced the maxilla posteriorly.Displaced the maxilla posteriorly.
Failed to stimulate mandibular growth, but didFailed to stimulate mandibular growth, but did
rotate the mandible backward.rotate the mandible backward.
Tipped the maxillary molars posteriorly andTipped the maxillary molars posteriorly and
intruded them.intruded them.
Significantly tipped the maxillary incisorsSignificantly tipped the maxillary incisors
posteriorly and extruded them.posteriorly and extruded them.
Significantly tipped, extruded, and moved theSignificantly tipped, extruded, and moved the
mandibular molars bodily in an anterior direction.mandibular molars bodily in an anterior direction.
Significantly tipped the mandibular incisorsSignificantly tipped the mandibular incisors
anteriorly and intruded them.anteriorly and intruded them.

JASPER JUMPERJASPER JUMPER

THE AMORIC TORSION COILSTHE AMORIC TORSION COILS
This appliance is made up of two springs, one ofThis appliance is made up of two springs, one of
which slides inside the other . They are interwhich slides inside the other . They are inter
maxillary springs without covering and have amaxillary springs without covering and have a
simplified application system of rings on thesimplified application system of rings on the
ends. These rings are fixed to the upper andends. These rings are fixed to the upper and
lower arches with double ligatures.lower arches with double ligatures.
They are marketed in one size only and areThey are marketed in one size only and are
bilateral. The force exerted by the appliance isbilateral. The force exerted by the appliance is
variable in accordance with the fixing points onvariable in accordance with the fixing points on
the archthe arch

AMORIC TORSION COILSAMORIC TORSION COILS

ADJUSTABLE BITE CORRECTORADJUSTABLE BITE CORRECTOR
((ABCABC))
This is an appliance which is assembled by theThis is an appliance which is assembled by the
orthodontist as it is composed of various pieces –orthodontist as it is composed of various pieces –
caps, closed coil springs, nickel titanium wirecaps, closed coil springs, nickel titanium wire
It can be used on either side of the mouth with aIt can be used on either side of the mouth with a
simple 180º rotation of the lower end cap tosimple 180º rotation of the lower end cap to
change its orientation. This reduces the inventorychange its orientation. This reduces the inventory
by as much as one half. In the center lumen ofby as much as one half. In the center lumen of
the spring we find a nickel titanium wire which isthe spring we find a nickel titanium wire which is
responsible for the "push" force generated.responsible for the "push" force generated.
Repairs and replacements are rapid and easilyRepairs and replacements are rapid and easily
carried out with this kit. The cost of repair is minorcarried out with this kit. The cost of repair is minorwww.indiandentalacademy.comwww.indiandentalacademy.com

ADJUSTABLE BITE CORRECTORADJUSTABLE BITE CORRECTOR

SCANDEE TUBULAR JUMPERSCANDEE TUBULAR JUMPER
This is a coated inter maxillary torsion spring soldThis is a coated inter maxillary torsion spring sold
in a kit which includes the spring, the covering,in a kit which includes the spring, the covering,
the connectors, the ball pins and the glue . Therethe connectors, the ball pins and the glue . There
is no distinction between left and right.is no distinction between left and right.
The covering can be of different colors making itThe covering can be of different colors making it
more attractive for patients. The orthodontistmore attractive for patients. The orthodontist
constructs the appliance, cutting the spring to theconstructs the appliance, cutting the spring to the
length seen fit. When a fracture occurs, it is onlylength seen fit. When a fracture occurs, it is only
necessary to replace individual components. Itnecessary to replace individual components. It
has the drawback of being thick after the coveringhas the drawback of being thick after the covering
is applied.is applied. www.indiandentalacademy.comwww.indiandentalacademy.com

SCANDEE TUBULAR JUMPERSCANDEE TUBULAR JUMPER

Klapper SUPER Spring IIKlapper SUPER Spring II
This is a flexible spring element which is attachedThis is a flexible spring element which is attached
between the maxillary molar and the mandibularbetween the maxillary molar and the mandibular
canine. The length of the element causes it to rest incanine. The length of the element causes it to rest in
the vestibule when activated. This facilitates hygienethe vestibule when activated. This facilitates hygiene
and avoids occlusal surfaces. The ends (fixing points)and avoids occlusal surfaces. The ends (fixing points)
are different: The open helical loop of the spring isare different: The open helical loop of the spring is
twisted like a J-hook onto the mandibular arch wire.twisted like a J-hook onto the mandibular arch wire.
On the maxillary end it is attached to the standardOn the maxillary end it is attached to the standard
headgear tube (Super Spring I) or to a special ovalheadgear tube (Super Spring I) or to a special oval
tube and secured with a stainless steel ligature (Supertube and secured with a stainless steel ligature (Super
Spring II). This new version prevents any lateralSpring II). This new version prevents any lateral
movement of the spring in the vestibule.movement of the spring in the vestibule.

Only two prefabricated sizes are availableOnly two prefabricated sizes are available
(with left and right versions of each). The(with left and right versions of each). The
length of the spring can be increased orlength of the spring can be increased or
decreased by simply bending thedecreased by simply bending the
attachment wires.attachment wires.
The horizontal configuration of theThe horizontal configuration of the
attachment wire at the maxillary molarattachment wire at the maxillary molar
tube permits distalization with goodtube permits distalization with good
radicular control.radicular control.

The SUPER spring II can be used in the entireThe SUPER spring II can be used in the entire
range of Class II cases, from vertical facialrange of Class II cases, from vertical facial
patterns with shallow overbites to brachyfacialpatterns with shallow overbites to brachyfacial
patterns with deep overbites.patterns with deep overbites.
It can be used with fully bracketed appliancesIt can be used with fully bracketed appliances
and it makes an ideal auxiliary for a variety ofand it makes an ideal auxiliary for a variety of
mechanical systems.mechanical systems.
The unique, unitary force couple applied by theThe unique, unitary force couple applied by the
spring against the maxillary molar allows aspring against the maxillary molar allows a
number of different applications. In the late mixednumber of different applications. In the late mixed
dentition, while the mandibular arch is fullydentition, while the mandibular arch is fully
bonded for anchorage, the maxillary molars canbonded for anchorage, the maxillary molars can
be distalized without bonding the adjacent teethbe distalized without bonding the adjacent teeth

Other Class II auxiliaries tend to distalizeOther Class II auxiliaries tend to distalize
only the maxillary molar crown, leaving theonly the maxillary molar crown, leaving the
root in a mesial position that must beroot in a mesial position that must be
corrected later in treatment. The SUPERcorrected later in treatment. The SUPER
spring II moves both crown and root with aspring II moves both crown and root with a
moderate, continuous force, and themoderate, continuous force, and the
adjacent teeth then follow the molaradjacent teeth then follow the molar
distally.distally.
The SUPER spring II has proven to beThe SUPER spring II has proven to be
excellent for TMD patients who requireexcellent for TMD patients who require
orthodontic treatment after splint therapy.orthodontic treatment after splint therapy.

Klapper SUPER spring IIKlapper SUPER spring II

BITE FIXERBITE FIXER
This is a new inter maxillary spring coil.This is a new inter maxillary spring coil.
The spring is attached and crimped to theThe spring is attached and crimped to the
end fitting to prevent breakage betweenend fitting to prevent breakage between
the spring and the end fitting.the spring and the end fitting.
Polyurethane tubing is inside the spring toPolyurethane tubing is inside the spring to
prevent it from becoming a food trap .prevent it from becoming a food trap .
The Bite Fixer is supplied in a kit withThe Bite Fixer is supplied in a kit with
various sizes for both left and rightvarious sizes for both left and right

BITE FIXERBITE FIXER

CHURRO JUMPERCHURRO JUMPER
This is an inexpensive alternative forceThis is an inexpensive alternative force
system for the antero posterior correctionsystem for the antero posterior correction
of Class II and Class III malocclusionsof Class II and Class III malocclusions
So far, this is the only flexible functionalSo far, this is the only flexible functional
appliance which can be made up by theappliance which can be made up by the
orthodontist in his lab. The costs areorthodontist in his lab. The costs are
reduced and the time spent is minimal.reduced and the time spent is minimal.

The mesial and distal end of the jumper are circles.The mesial and distal end of the jumper are circles.
The distal circle is attached to the maxillary molarsThe distal circle is attached to the maxillary molars
by a pin and the mesial end is placed over theby a pin and the mesial end is placed over the
mandibular arch wire against the canine bracket.mandibular arch wire against the canine bracket.
However, when the pin is pulled forward enough toHowever, when the pin is pulled forward enough to
cause the jumper to bow outward toward the cheek,cause the jumper to bow outward toward the cheek,
the appliance begins to exert a distal and intrusivethe appliance begins to exert a distal and intrusive
force against the maxillary molar and a forward andforce against the maxillary molar and a forward and
intrusive force against the mandibular incisors as itintrusive force against the mandibular incisors as it
attempts to straighten When used as a Class IIattempts to straighten When used as a Class II
corrector, the Churro exerts a posterior force on thecorrector, the Churro exerts a posterior force on the
maxillary arch and an anterior force on themaxillary arch and an anterior force on the
mandibular arch, much like the Jasper Jumper.mandibular arch, much like the Jasper Jumper.

The Churro Jumper as a Class IIIThe Churro Jumper as a Class III
ForceForce
The Churro Jumper, unlike many other Class IIThe Churro Jumper, unlike many other Class II
appliances, can be adapted to provide a well –appliances, can be adapted to provide a well –
designed force for correction of Class IIIdesigned force for correction of Class III
malocclusions.malocclusions.
In the Class III version, the terminal circles areIn the Class III version, the terminal circles are
placed against the mesial of the mandibularplaced against the mesial of the mandibular
molar tube and the distal of the maxillary caninemolar tube and the distal of the maxillary canine
bracket.bracket.
Ordinarily, the distance between the maxillaryOrdinarily, the distance between the maxillary
canine and first premolar brackets is enough tocanine and first premolar brackets is enough to
allow the jumper to open adequately and slideallow the jumper to open adequately and slide
easily. If there is any restriction, however, theeasily. If there is any restriction, however, the
premolar bracket can be removed.premolar bracket can be removed.www.indiandentalacademy.comwww.indiandentalacademy.com

Although the anterior (maxillary) circle canAlthough the anterior (maxillary) circle can
extend in a straight line from the shaft of theextend in a straight line from the shaft of the
jumper, it is preferable to add a vertical bendjumper, it is preferable to add a vertical bend
that converts the Churro Jumper's force into athat converts the Churro Jumper's force into a
Class I vector, which produces less verticalClass I vector, which produces less vertical
thrust, incisor flaring, and anterior bitethrust, incisor flaring, and anterior bite
opening.opening.
This vertical bend also allows the Churro to lieThis vertical bend also allows the Churro to lie
unobtrusively in the mandibular vestibule,unobtrusively in the mandibular vestibule,
making it less noticeable and bothersome formaking it less noticeable and bothersome for
the patient.the patient.
The Churro Jumper can improve theThe Churro Jumper can improve the
effectiveness of orthodontic therapy in Classeffectiveness of orthodontic therapy in Class
III patients who refuse to wear Class IIIIII patients who refuse to wear Class III
elasticselastics www.indiandentalacademy.comwww.indiandentalacademy.com

CHURRO JUMPER FORCHURRO JUMPER FOR
CLASS IIICLASS III

The Churro Jumper has several disadvantagesThe Churro Jumper has several disadvantages
that sometimes limit its usefulness:that sometimes limit its usefulness:
The restriction of mouth opening to 30-40mm isThe restriction of mouth opening to 30-40mm is
intolerable for some patients.intolerable for some patients.
Arch wire breakage is common if larger wiresArch wire breakage is common if larger wires
are not used.are not used.
Patients with a low tolerance for discomfort willPatients with a low tolerance for discomfort will
often break the appliance (as well as the spirit ofoften break the appliance (as well as the spirit of
the orthodontist).the orthodontist).
Patients who incessantly move their mouthsPatients who incessantly move their mouths
with chewing, talking, and nervous tics will farewith chewing, talking, and nervous tics will fare
poorly with it.poorly with it.
Its maximum effectiveness depends on aIts maximum effectiveness depends on a
permanent dentition to retain its effect.permanent dentition to retain its effect.
Presently, it must be manufactured in the officePresently, it must be manufactured in the office

Nevertheless, the Churro Jumper has considerableNevertheless, the Churro Jumper has considerable
advantages:advantages:
It provides a constant, indefatigable force that cannot beIt provides a constant, indefatigable force that cannot be
removed from the mouth.removed from the mouth.
It can be used either unilaterally or bilaterally.It can be used either unilaterally or bilaterally.
It can be used to correct Class II or Class IIIIt can be used to correct Class II or Class III
malocclusions.malocclusions.
It helps maintain anchorage, since it prevents theIt helps maintain anchorage, since it prevents the
maxillary molars and mandibular incisors from moving intomaxillary molars and mandibular incisors from moving into
extraction sites.extraction sites.
The cost of construction for materials and labor is less.The cost of construction for materials and labor is less.
It can be made as needed, from materials already presentIt can be made as needed, from materials already present
in most orthodontic offices, and does not require anin most orthodontic offices, and does not require an
expensive inventory.expensive inventory.
It is universal in size and can be adapted to fit anyIt is universal in size and can be adapted to fit any
malocclusion.malocclusion.
When broken, it is easily and inexpensively removed andWhen broken, it is easily and inexpensively removed and
replacedreplaced

CHURRO JUMPERCHURRO JUMPER

Rigid Fixed FunctionalRigid Fixed Functional
Appliances - RFFAAppliances - RFFA
These appliances have two distinct differencesThese appliances have two distinct differences
in relation to FFFAs:in relation to FFFAs:
RFFAs do not easily fracture but neither do theyRFFAs do not easily fracture but neither do they
have elasticity or flexibility.have elasticity or flexibility.
After fitting and activation they do not allow theAfter fitting and activation they do not allow the
patient to close in centric relation. This meanspatient to close in centric relation. This means
that the mandible is in a forward position 24that the mandible is in a forward position 24
hours a day creating greater stimulus forhours a day creating greater stimulus for
mandibular growth than with FFFAs.mandibular growth than with FFFAs.

Main indication is for the treatment of Class IIMain indication is for the treatment of Class II
malocclusions. Basically, correction consistsmalocclusions. Basically, correction consists
of advancing the mandible to a forced anteriorof advancing the mandible to a forced anterior
position to stimulate growth and harmonizeposition to stimulate growth and harmonize
skeletal defects. The majority of theseskeletal defects. The majority of these
appliances do not adapt to the treatment ofappliances do not adapt to the treatment of
Class III cases.Class III cases.

TREATMENT EFFECTS OFTREATMENT EFFECTS OF
HERBSTHERBST
SAGITTAL CHANGESSAGITTAL CHANGES::
The Herbst appliance restrains maxillary growth andThe Herbst appliance restrains maxillary growth and
stimulates mandibular growthstimulates mandibular growth
Sagittal condylar growth increases where as verticalSagittal condylar growth increases where as vertical
condylar growth is relatively unaffectedcondylar growth is relatively unaffected
Bone remodeling process in the lower mandibularBone remodeling process in the lower mandibular
border change the morphology of the mandibleborder change the morphology of the mandible
Experimental evidence indicate that articular fossa isExperimental evidence indicate that articular fossa is
repositioned anteriorlyrepositioned anteriorly

DENTAL CHANGESDENTAL CHANGES
The mandibular teeth are moved anteriorlyThe mandibular teeth are moved anteriorly
Mandibular incisors are proclinedMandibular incisors are proclined
Maxillary teeth are moved posteriorlyMaxillary teeth are moved posteriorly
Maxillary teeth are distalized as well asMaxillary teeth are distalized as well as
intrudedintruded

VERTICAL CHANGESVERTICAL CHANGES
Deep over bite may be reducedDeep over bite may be reduced
significantlysignificantly
Overbite reduction is mainly by intrusion ofOverbite reduction is mainly by intrusion of
lower incisors and enhanced eruption oflower incisors and enhanced eruption of
lower molarslower molars
Maxillary and mandibular occlusal planesMaxillary and mandibular occlusal planes
tip downtip down

Histological changesHistological changes
MRI studies of RUF and PANCHERZMRI studies of RUF and PANCHERZ
showed thatshowed that
Increased proliferation of the condylarIncreased proliferation of the condylar
cartilage was noted. These adaptationscartilage was noted. These adaptations
occurred primarily in the posterior andoccurred primarily in the posterior and
posterio superior regions of the condyleposterio superior regions of the condyle
Significant deposition of the new bone onSignificant deposition of the new bone on
the anterior surface of the postglenoid spinethe anterior surface of the postglenoid spine
occurred, indicating an anterior repositioningoccurred, indicating an anterior repositioning
of glenoid fossaof glenoid fossa

Significant bone resorption on the posteriorSignificant bone resorption on the posterior
surface of the postglenoid spine was notedsurface of the postglenoid spine was noted
Significant bony apposition on the posteriorSignificant bony apposition on the posterior
border of the mandibular ramus was evidentborder of the mandibular ramus was evident
during early experimental periodsduring early experimental periods
No gross or microscopic pathologicalNo gross or microscopic pathological
changes were noted in the temporochanges were noted in the temporo
mandibular joints.mandibular joints.

Variations on the Herbst appliance and similarVariations on the Herbst appliance and similar
systems, utilizing ball attachments havesystems, utilizing ball attachments have
appeared on the market in an attempt to:appeared on the market in an attempt to:
improve patient comfort and acceptanceimprove patient comfort and acceptance
cause fewer clinical problems compared tocause fewer clinical problems compared to
screw or pin attachmentsscrew or pin attachments
reduce the frequency of emergencyreduce the frequency of emergency
appointmentsappointments
allow good lateral mandibular movementsallow good lateral mandibular movements
allow easy application in splints for correction inallow easy application in splints for correction in
mixed dentitionmixed dentition

TYPE I HERBSTTYPE I HERBST

TYPE II HERBSTTYPE II HERBST
Type II has a fixing system that fits directlyType II has a fixing system that fits directly
onto the arch wires through the use ofonto the arch wires through the use of
screws. This method of application has thescrews. This method of application has the
disadvantage of causing constantdisadvantage of causing constant
fractures in the arch wires. The lack offractures in the arch wires. The lack of
flexibility together with the difficulty inflexibility together with the difficulty in
lateral movements and the stress placedlateral movements and the stress placed
on the arch wires through activationon the arch wires through activation
causes fractures, especially in the lowercauses fractures, especially in the lower
arch.arch.

TYPE II HERBSTTYPE II HERBST

TYPE IV HERBSTTYPE IV HERBST
Type IV has a fixation system with a ballType IV has a fixation system with a ball
attachment, which allows greater flexibilityattachment, which allows greater flexibility
and freedom of mandibular movement. Aand freedom of mandibular movement. A
disadvantage in relation to other similardisadvantage in relation to other similar
appliances is the fact that it needs brakesappliances is the fact that it needs brakes
to stabilize the joint. The brakes are smallto stabilize the joint. The brakes are small
and sometime difficult to fit. When aand sometime difficult to fit. When a
fracture occurs or a brake is lost, thefracture occurs or a brake is lost, the
appliance becomes loose .appliance becomes loose .

TYPE IV HERBSTTYPE IV HERBST

THE CANTILEVER BITE JUMPERTHE CANTILEVER BITE JUMPER
Most recently, the use of a cantilever has beenMost recently, the use of a cantilever has been
proposed . The biggest difference resides in theproposed . The biggest difference resides in the
fact that the Herbst style appliance is fitted directlyfact that the Herbst style appliance is fitted directly
to the lower molar bands through a cantilever arm.to the lower molar bands through a cantilever arm.
This system means that crowns have to be fitted toThis system means that crowns have to be fitted to
the upper and lower molars. The cantilever securedthe upper and lower molars. The cantilever secured
to the mandibular stainless steel crowns has ato the mandibular stainless steel crowns has a
disadvantage in that the thickness of the screwdisadvantage in that the thickness of the screw
mechanism can impinge on the patient’s cheek.mechanism can impinge on the patient’s cheek.
The parts are available in kit form with pre-weldedThe parts are available in kit form with pre-welded
screw mechanisms and cantilever arms on crownsscrew mechanisms and cantilever arms on crowns
of seven different sizes.of seven different sizes.www.indiandentalacademy.comwww.indiandentalacademy.com

CANTI LEVER BITE JUMPERCANTI LEVER BITE JUMPER

MALU HERBST APPLAINCEMALU HERBST APPLAINCE
The MALU – Mandibular AdvancementThe MALU – Mandibular Advancement
Locking Unit is a recently developedLocking Unit is a recently developed
attachment device for the Herbst . Itattachment device for the Herbst . It
consists of two tubes, two plungers, twoconsists of two tubes, two plungers, two
upper "Mobee" hinges with ball pins andupper "Mobee" hinges with ball pins and
two lower key hinges with brass pins.two lower key hinges with brass pins.
The major advantages are the lower cost,The major advantages are the lower cost,
no laboratory needed, flexibility and theno laboratory needed, flexibility and the
possibility of using combined withpossibility of using combined with
edgewise therapyedgewise therapywww.indiandentalacademy.comwww.indiandentalacademy.com

Each upper Mobee hinge is insertedEach upper Mobee hinge is inserted
into the hole at the end of the MALUinto the hole at the end of the MALU
tube and secured to the first molartube and secured to the first molar
headgear tube with ball pin. Each lowerheadgear tube with ball pin. Each lower
key hinge is inserted into the hole atkey hinge is inserted into the hole at
the end of the plunger and locked tothe end of the plunger and locked to
the base arch, distal to the cuspid, withthe base arch, distal to the cuspid, with
the brass pin.the brass pin.

MALU HERBSTMALU HERBST

FLIP LOCK HERBST APPLAINCEFLIP LOCK HERBST APPLAINCE
The Flip-Lock Herbst appliance offersThe Flip-Lock Herbst appliance offers
several advantages over conventionalseveral advantages over conventional
Herbst designs:Herbst designs:
•• Improved patient comfort and acceptanceImproved patient comfort and acceptance
•• Fewer clinical problems compared toFewer clinical problems compared to
screw or pin attachmentsscrew or pin attachments
•• Less chair time for reactivationLess chair time for reactivation
•• Less frequent emergency appointmentsLess frequent emergency appointments

FIRST GENERATIONFIRST GENERATION
The first generation was made from aThe first generation was made from a
dense polysulfone plastic but breakagedense polysulfone plastic but breakage
occurred because of the forces generatedoccurred because of the forces generated
within the ball-joint attachment .within the ball-joint attachment .

FIRST GENERATION FLIP L0CKFIRST GENERATION FLIP L0CK

SECOND GENERATION FLIPSECOND GENERATION FLIP
LOCKLOCK
In the second generation, the plastic wasIn the second generation, the plastic was
replaced with metal. However, fracturereplaced with metal. However, fracture
problems persisted.problems persisted.

THIRD GENERATION FLIP LOCKTHIRD GENERATION FLIP LOCK
The third generation is made of a horse-The third generation is made of a horse-
shoe ball joint. This system has proved toshoe ball joint. This system has proved to
be more efficient than the previousbe more efficient than the previous
models, both in terms of application asmodels, both in terms of application as
well as its resistance to fracture (Miller R.,well as its resistance to fracture (Miller R.,
1996)1996)

FLIP LOCK THIRD GENERATIONFLIP LOCK THIRD GENERATION

THE VENTRAL TELESCOPETHE VENTRAL TELESCOPE
This was the first telescopic RFFA thatThis was the first telescopic RFFA that
appeared as a single unit; i.e. uponappeared as a single unit; i.e. upon
reaching maximum opening it does notreaching maximum opening it does not
come apart .come apart .
This appliance is available in two sizes andThis appliance is available in two sizes and
fixing is achieved through ballfixing is achieved through ball
attachments. It is particularly easy toattachments. It is particularly easy to
activate. The operation is simple and isactivate. The operation is simple and is
carried out by unscrewing the tube thuscarried out by unscrewing the tube thus
allowing an activation of around 3 mm.allowing an activation of around 3 mm.www.indiandentalacademy.comwww.indiandentalacademy.com

Its disadvantages lie in the fact that it isIts disadvantages lie in the fact that it is
quite thick and suffers from fractures toquite thick and suffers from fractures to
the brake which stabilizes the joint. As withthe brake which stabilizes the joint. As with
the other appliances where fixing isthe other appliances where fixing is
achieved through ball attachments, greatachieved through ball attachments, great
accuracy is necessary with regard toaccuracy is necessary with regard to
inclination and the welding of componentsinclination and the welding of components..

VENTRAL TELESCOPEVENTRAL TELESCOPE

THE MAGNETIC TELESCOPICTHE MAGNETIC TELESCOPIC
DEVICEDEVICE
This consists of two tubes and two plungers withThis consists of two tubes and two plungers with
a semi-circular section and with NdFeB magnetsa semi-circular section and with NdFeB magnets
placed in such a manner that a repelling force isplaced in such a manner that a repelling force is
exerted . Fitting is achieved by using the MALUexerted . Fitting is achieved by using the MALU
systemsystem
This appliance has the advantage of linking aThis appliance has the advantage of linking a
magnetic field to the functional appliance. Itsmagnetic field to the functional appliance. Its
main disadvantages are its thickness, themain disadvantages are its thickness, the
laboratory work necessary to prepare it and thelaboratory work necessary to prepare it and the
covering of the magnets.covering of the magnets.

MAGNETIC TELESCOPICMAGNETIC TELESCOPIC
DEVICEDEVICE

THE MANDIBULARTHE MANDIBULAR
PROTRACTION APPLIANCEPROTRACTION APPLIANCE
(MPA)(MPA)
This is an RFFA which was developed to be quicklyThis is an RFFA which was developed to be quickly
made up by the orthodontist in the laboratorymade up by the orthodontist in the laboratory
Its advantages include ease of manufacture, low cost,Its advantages include ease of manufacture, low cost,
infrequent breakage, patient comfort and rapid fitting.infrequent breakage, patient comfort and rapid fitting.
Another advantage it offers is that it can be made upAnother advantage it offers is that it can be made up
at any time. This is helpful when there has been aat any time. This is helpful when there has been a
failure in the supply of other commercially availablefailure in the supply of other commercially available
appliances or if the orthodontist practices in an areaappliances or if the orthodontist practices in an area
where it is difficult to quickly obtain certain otherwhere it is difficult to quickly obtain certain other
alternatives.alternatives.
The designer of the MPA developed three differentThe designer of the MPA developed three different
typestypes www.indiandentalacademy.comwww.indiandentalacademy.com

MPA IMPA I
MPA I – each side of the appliance is made byMPA I – each side of the appliance is made by
bending a small loop at a right angle to the end of anbending a small loop at a right angle to the end of an
.032" SS wire. The length of the appliance is then.032" SS wire. The length of the appliance is then
determined by protruding the mandible and anotherdetermined by protruding the mandible and another
small right-angle circle is then bent in an oppositesmall right-angle circle is then bent in an opposite
direction. The appliance slides distally along thedirection. The appliance slides distally along the
mandibular arch wire and mesially along themandibular arch wire and mesially along the
maxillary arch wire. Bicuspid brackets must bemaxillary arch wire. Bicuspid brackets must be
debonded.debonded.
Limited mouth opening is the major disadvantage.Limited mouth opening is the major disadvantage.

MPA IIMPA II
MPA II – this is made by making right-MPA II – this is made by making right-
angles circles in two pieces of .032" SSangles circles in two pieces of .032" SS
wire. A small piece of slipped coil iswire. A small piece of slipped coil is
slipped over one of the wires. One end ofslipped over one of the wires. One end of
each wire is then inserted through the loopeach wire is then inserted through the loop
in the other wire. This version allows thein the other wire. This version allows the
mouth to open wider than the first version.mouth to open wider than the first version.

MPAIIIMPAIII
MPA III – This version eliminates much of theMPA III – This version eliminates much of the
arch wire stress that occurs with the MPA Iarch wire stress that occurs with the MPA I
and II. It permits a greater range of jawand II. It permits a greater range of jaw
movement while keeping the mandible in amovement while keeping the mandible in a
protruded position. It is adaptable to eitherprotruded position. It is adaptable to either
Class II or Class III mal occlusions. ItClass II or Class III mal occlusions. It
resembles the Herbst by also incorporating aresembles the Herbst by also incorporating a
telescoping mechanism but is smaller in size.telescoping mechanism but is smaller in size.
It requires more time to be built and a goodIt requires more time to be built and a good
electronic welder that does not darken orelectronic welder that does not darken or
weaken the wire.weaken the wire.www.indiandentalacademy.comwww.indiandentalacademy.com

MANDIBULAR PROTRACTIONMANDIBULAR PROTRACTION
APPLIANCEAPPLIANCE

THE UNIVERSAL BITETHE UNIVERSAL BITE
JUMPER(UBJ)JUMPER(UBJ)
This is like a Herbst but is smaller in size and moreThis is like a Herbst but is smaller in size and more
versatile – it can be used in all phases of treatmentversatile – it can be used in all phases of treatment
in mixed or permanent dentition, Class II or IIIin mixed or permanent dentition, Class II or III
malocclusions. An active coil spring can be added ifmalocclusions. An active coil spring can be added if
necessarynecessary
No laboratory preparation is required. It is fitted inNo laboratory preparation is required. It is fitted in
the patient’s mouth and cut to the appropriatethe patient’s mouth and cut to the appropriate
length for the desired mandibular advancement.length for the desired mandibular advancement.
Activations are made by crimping 2-4 mm splintActivations are made by crimping 2-4 mm splint
bushings onto the rods. UBJs with nickel titaniumbushings onto the rods. UBJs with nickel titanium
coil springs do not need to be reactivatedcoil springs do not need to be reactivatedwww.indiandentalacademy.comwww.indiandentalacademy.com

The UBJ offers the following advantages:The UBJ offers the following advantages:
It is simple, sturdy, and inexpensive.It is simple, sturdy, and inexpensive.
Inventory requirements are minimal--the UBJ can be used onInventory requirements are minimal--the UBJ can be used on
either side of the mouth, and there is only one size, since it iseither side of the mouth, and there is only one size, since it is
cut to the desired length for each case.cut to the desired length for each case.
It can be used at any stage of treatment --in the early mixedIt can be used at any stage of treatment --in the early mixed
dentition to obtain an immediate mandibular advancementdentition to obtain an immediate mandibular advancement
before any dental alignment, or in the permanent dentition forbefore any dental alignment, or in the permanent dentition for
fixed functional treatment.fixed functional treatment.
It can be used in Class II or Class III cases.It can be used in Class II or Class III cases.
Its low profile results in considerably less buccal irritationIts low profile results in considerably less buccal irritation
than with similar appliances.than with similar appliances.
Patient comfort and acceptance are excellent.Patient comfort and acceptance are excellent.
It can easily be attached to removable splints for maximumIt can easily be attached to removable splints for maximum
anchorage.anchorage.
It produces good results without the need for patientIt produces good results without the need for patient
cooperation.cooperation. www.indiandentalacademy.comwww.indiandentalacademy.com

UNIVERSAL BITE JUMPERUNIVERSAL BITE JUMPER

THE BIOPEDIC APPLIANCETHE BIOPEDIC APPLIANCE
This is a bite jumping appliance which isThis is a bite jumping appliance which is
engaged on the maxillary and mandibularengaged on the maxillary and mandibular
molars, using a cantilever like system. It is thenmolars, using a cantilever like system. It is then
attached to a BioPedic buccal tubeattached to a BioPedic buccal tube
Activation is achieved by sliding the applianceActivation is achieved by sliding the appliance
along the buccal tube and fixing the screw. It isalong the buccal tube and fixing the screw. It is
universally sized for left and right sides. Twouniversally sized for left and right sides. Two
pivots on the ends allow the appliance to bepivots on the ends allow the appliance to be
rotated when the patient opens his mouth.rotated when the patient opens his mouth.

BIOPEDIC APPLAINCEBIOPEDIC APPLAINCE

The Mandibular AnteriorThe Mandibular Anterior
Repositioning Appliance (MARA)Repositioning Appliance (MARA)
This was created by Douglas Toll of Germany in 1991.This was created by Douglas Toll of Germany in 1991.
It consisted of cams on the molars which guided theIt consisted of cams on the molars which guided the
patient to bite into Class Ipatient to bite into Class I
The first molars have to be covered with stainlessThe first molars have to be covered with stainless
steel crowns and the appliance must be laboratorysteel crowns and the appliance must be laboratory
manufactured.manufactured.
The patient can pull back his mandible to a Class IIThe patient can pull back his mandible to a Class II
relation but will be unable to achieve intercuspidation.relation but will be unable to achieve intercuspidation.
This means that the lower molars will make directThis means that the lower molars will make direct
contact with the metal, giving an unpleasantcontact with the metal, giving an unpleasant
sensation. Furthermore, should the orthodontist opt forsensation. Furthermore, should the orthodontist opt for
bands instead of crowns, fractures will often occur.bands instead of crowns, fractures will often occur.www.indiandentalacademy.comwww.indiandentalacademy.com

The appliance design allows for use inThe appliance design allows for use in
conjunction with braces. It can be used forconjunction with braces. It can be used for
Class II treatment and for TMJ problems.Class II treatment and for TMJ problems.
this is an appliance of simplethis is an appliance of simple
characteristics which allows good hygienecharacteristics which allows good hygiene
during the correction stage. With a smallduring the correction stage. With a small
modification to the original design usingmodification to the original design using
only wire and composite, a very interestingonly wire and composite, a very interesting
appliance can be created for finishingappliance can be created for finishing
treatment of a Class II malocclusiontreatment of a Class II malocclusion
treated with a functional appliance.treated with a functional appliance.

INDICATIONS:INDICATIONS:
Skeletal class II with mandibularSkeletal class II with mandibular
deficiencydeficiency
CONTRA INDICATIONS:CONTRA INDICATIONS:
Dolichofacial growth patternDolichofacial growth pattern
Cases predisposed to root resorptionCases predisposed to root resorption
Dental and skeletal open bitesDental and skeletal open bites
Vertical growth with high mandibular planeVertical growth with high mandibular plane
angle and excessive lower facial heightangle and excessive lower facial height

MARAMARA

RITTO APPLIANCERITTO APPLIANCE
The Ritto appliance is a rigid fixedThe Ritto appliance is a rigid fixed
functional appliance that can befunctional appliance that can be
described as a miniaturized telescopicdescribed as a miniaturized telescopic
device.device. The Ritto Appliance is a one-The Ritto Appliance is a one-
piece device with telescopic action. Itpiece device with telescopic action. It
comes in a single format, which allowscomes in a single format, which allows
it to be used on both sides. This designit to be used on both sides. This design
means that stock can be kept atmeans that stock can be kept at
minimum levels.minimum levels.

THE RITTO APPLAINCETHE RITTO APPLAINCE
The Ritto Appliance can be described as aThe Ritto Appliance can be described as a
miniaturized telescopic device with simplifiedminiaturized telescopic device with simplified
intra oral application and activation Theintra oral application and activation The
construction of this appliance is based on theconstruction of this appliance is based on the
mechanism and function used in the Ventralmechanism and function used in the Ventral
Telescope adapted for use in conjunction with aTelescope adapted for use in conjunction with a
fixed appliancefixed appliance

They cause less breakage of arch wires andThey cause less breakage of arch wires and
appliances and thus fewer emergencyappliances and thus fewer emergency
appointmentsappointments
- Inventory requirements are minimal – The- Inventory requirements are minimal – The
appliance can be used on either side of the mouthappliance can be used on either side of the mouth
and there is only one sizeand there is only one size
- They can be used at any stage of treatment –- They can be used at any stage of treatment –
mixed or permanentmixed or permanent
- Their low profile results in considerably less- Their low profile results in considerably less
buccal irritationbuccal irritation
- They produce good results without the need for- They produce good results without the need for
patient cooperation.patient cooperation.

In functional treatment with a rigid fixedIn functional treatment with a rigid fixed
functional appliance (RFFA), it is necessary tofunctional appliance (RFFA), it is necessary to
prepare the patient for 1 to 2 months beforeprepare the patient for 1 to 2 months before
fitting the appliance to stimulate musculaturefitting the appliance to stimulate musculature
and avoid having the patient exert too muchand avoid having the patient exert too much
force on the support systems, causing applianceforce on the support systems, causing appliance
breakage or unwanted dental movement. Forbreakage or unwanted dental movement. For
this reason, the use of a mini-stimulator forthis reason, the use of a mini-stimulator for
mandibular advancement is advised. This is amandibular advancement is advised. This is a
thermoformed splint of 0.7 mm in thickness, forthermoformed splint of 0.7 mm in thickness, for
the upper incisors only and incorporating anthe upper incisors only and incorporating an
acrylic bite block for the lower incisors. The biteacrylic bite block for the lower incisors. The bite
block is constructed with the mandible in ablock is constructed with the mandible in a
forward position.forward position.

For the first 15 days or 1 month, the patientFor the first 15 days or 1 month, the patient
should wear the splint for as long as possibleshould wear the splint for as long as possible
and maintain the lower incisors fitted into theand maintain the lower incisors fitted into the
Bite block. In the following weeks, the patientBite block. In the following weeks, the patient
should practice swallowing exercises with theshould practice swallowing exercises with the
lips in contact and with lower incisors against thelips in contact and with lower incisors against the
bite block.bite block.
Only after this stage should therapy be startedOnly after this stage should therapy be started
with the Ritto Appliance, now that thewith the Ritto Appliance, now that the
musculature has been stimulated and the patientmusculature has been stimulated and the patient
has memorized the forward position of thehas memorized the forward position of the
mandible. Delocking of the occlusion is alsomandible. Delocking of the occlusion is also
achieved.achieved.
It is possible to fit the Ritto appliance inIt is possible to fit the Ritto appliance in
conjunction with the mini stimulator for the firstconjunction with the mini stimulator for the first
few weeksfew weeks

Another important factor that contributes to comfortAnother important factor that contributes to comfort
and rapid patient adaptation is the establishment ofand rapid patient adaptation is the establishment of
posterior contact after the advancement of theposterior contact after the advancement of the
mandible. This also creates a posteriormandible. This also creates a posterior
proprioceptive sense. It is not always necessary toproprioceptive sense. It is not always necessary to
have perfect coordination of the arches beforehave perfect coordination of the arches before
starting functional treatment. Sometimes, even with astarting functional treatment. Sometimes, even with a
pronounced Curve of Spee, therapy can be startedpronounced Curve of Spee, therapy can be started
as long as some artificial contacts are constructedas long as some artificial contacts are constructed
with composites on the molars . The extrusion of thewith composites on the molars . The extrusion of the
premolars can be beneficial in the correction of apremolars can be beneficial in the correction of a
vertical problem.vertical problem.

MINI STIMULATORMINI STIMULATOR

RITTO APPLAINCERITTO APPLAINCE

RITTO APPLIANCERITTO APPLIANCE

APPLAINCE FIXED TOAPPLAINCE FIXED TO
ARCH WIREARCH WIRE

The main differences when compared to theThe main differences when compared to the
Ventral Telescope appliance are:Ventral Telescope appliance are:
The appliance does not come apart (noThe appliance does not come apart (no
disengagement after achieving maximumdisengagement after achieving maximum
extension).extension).
The smaller size facilitates adaptation and it doesThe smaller size facilitates adaptation and it does
not affect aesthetic appearance or speech.not affect aesthetic appearance or speech.
It comes in a single format which allows it to beIt comes in a single format which allows it to be
used on both sides and is available in only oneused on both sides and is available in only one
size.size.
The Ritto Appliance is simple to use, comfortable,The Ritto Appliance is simple to use, comfortable,
cost effective, breakage resistant and requires nocost effective, breakage resistant and requires no
patient cooperationpatient cooperation

It is even possible to carry out the treatmentIt is even possible to carry out the treatment
of Class II retromandibular cases in mixed orof Class II retromandibular cases in mixed or
permanent dentition using only conventionalpermanent dentition using only conventional
bands on the upper molars and two tubes onbands on the upper molars and two tubes on
the lower molars and brackets on the lowerthe lower molars and brackets on the lower
incisors.incisors.
Fixation accessories consist of a steel ballFixation accessories consist of a steel ball
pin and a lock . Upper fixation is carried outpin and a lock . Upper fixation is carried out
by placing a steel ball pin from the distal intoby placing a steel ball pin from the distal into
the .045 headgear tube on the upper molarthe .045 headgear tube on the upper molar
band, through the appliance eyelet and thenband, through the appliance eyelet and then
bending it back .bending it back .www.indiandentalacademy.comwww.indiandentalacademy.com

The appliance is fixed onto a prepared theThe appliance is fixed onto a prepared the
lower arch. The thickness and type of archlower arch. The thickness and type of arch
is chosen, its length is adjusted, locks areis chosen, its length is adjusted, locks are
fitted and the Ritto appliance is thenfitted and the Ritto appliance is then
inserted. Activation is achieved by slidinginserted. Activation is achieved by sliding
the lock along the lower arch in the distalthe lock along the lower arch in the distal
direction and then fixing it against the Rittodirection and then fixing it against the Ritto
Appliance .Appliance .

The most common question raised on thisThe most common question raised on this
appliance is on the effect produced on theappliance is on the effect produced on the
lower incisors, given that the lower anchoragelower incisors, given that the lower anchorage
system is minimal. In a comparative studysystem is minimal. In a comparative study
between the Ritto Appliance and the Herbstbetween the Ritto Appliance and the Herbst
appliance, no statistically significantappliance, no statistically significant
differences were found in the position of thedifferences were found in the position of the
lower incisors . In a scanogram analysis of thelower incisors . In a scanogram analysis of the
lower incisors, no indication of radicularlower incisors, no indication of radicular
resorption was found during treatment with theresorption was found during treatment with the
appliance.appliance.

SABBAGH UNIVERSAL SPRINGSABBAGH UNIVERSAL SPRING
Is the ideal solution for treating patients withIs the ideal solution for treating patients with::
Insufficient cooperationInsufficient cooperation
Late cases with little remaining growthLate cases with little remaining growth
Illnesses of the upper respiratory tract system,Illnesses of the upper respiratory tract system,
such as asthmasuch as asthma
Patients who are allergic to plasticsPatients who are allergic to plastics
The Sabbagh Universal Spring can beThe Sabbagh Universal Spring can be
universally used as a substitute for activator,universally used as a substitute for activator,
Herbst , headgear, elastics, as well as for theHerbst , headgear, elastics, as well as for the
treatment of temporo mandibular dysfunction.treatment of temporo mandibular dysfunction.www.indiandentalacademy.comwww.indiandentalacademy.com

SABBAGH UNIVERSALSABBAGH UNIVERSAL
SPRINGSPRING

The appropriate size can be adjusted by turningThe appropriate size can be adjusted by turning
the inner telescope tube, as well as insertingthe inner telescope tube, as well as inserting
activation springs (tension or compressionactivation springs (tension or compression
springs). Compared to other similar appliances,springs). Compared to other similar appliances,
the Sabbagh Universal Spring has manythe Sabbagh Universal Spring has many
possibilities for activation, such as turning thepossibilities for activation, such as turning the
inner telescope tube, or inserting the activationinner telescope tube, or inserting the activation
springs (tension or compression springs)springs (tension or compression springs)
Therefore, in most cases only one SabbaghTherefore, in most cases only one Sabbagh
Universal Spring set is required for the entireUniversal Spring set is required for the entire
treatment.treatment.

HYBRID APPLAINCESHYBRID APPLAINCES
There are also new appliances that canThere are also new appliances that can
been classified as hybrid appliancesbeen classified as hybrid appliances
because they represent the combination of abecause they represent the combination of a
Rigid fixed functional appliance (RFFA) withRigid fixed functional appliance (RFFA) with
Flexible fixed functional appliance (FFFA).Flexible fixed functional appliance (FFFA).
They could be described as rigid appliancesThey could be described as rigid appliances
with coil spring-type systems.with coil spring-type systems.

The objective of these appliances is to moveThe objective of these appliances is to move
the teeth by applying 24-hour elasticthe teeth by applying 24-hour elastic
continuous force that would replace thecontinuous force that would replace the
traditional use of elastics and extra-oraltraditional use of elastics and extra-oral
force. Their common feature the use offorce. Their common feature the use of
coiled springs to produce this force. Thecoiled springs to produce this force. The
force generated varies between 150 and 200force generated varies between 150 and 200
gm. Other advantages include reduction ingm. Other advantages include reduction in
the need for patient cooperation and thethe need for patient cooperation and the
ease of placementease of placement

The primary objective of the hybridThe primary objective of the hybrid
appliances is not to reposition the mandibleappliances is not to reposition the mandible
anteriorly. If such was the case, it would beanteriorly. If such was the case, it would be
illogical to reposition a mandible and at theillogical to reposition a mandible and at the
same time to keep exerting mesial inferiorsame time to keep exerting mesial inferior
and distal superior force. Rigid fixedand distal superior force. Rigid fixed
functional appliances offer the best choice tofunctional appliances offer the best choice to
obtain this goal, as is well documented in theobtain this goal, as is well documented in the
literature. With RFFAs, once the applianceliterature. With RFFAs, once the appliance
has been activated the patient cannot closehas been activated the patient cannot close
in centric relation during the therapy stage.in centric relation during the therapy stage.

In order to obtain the best possible results with aIn order to obtain the best possible results with a
goal of skeletal movement, the authors propose agoal of skeletal movement, the authors propose a
philosophy of using muscular pre-stimulation beforephilosophy of using muscular pre-stimulation before
the placement of the fixed appliance. This is inthe placement of the fixed appliance. This is in
conjunction with a treatment plan based on anconjunction with a treatment plan based on an
individualized pattern model. A generalindividualized pattern model. A general
inconvenience with rigid fixed functional appliancesinconvenience with rigid fixed functional appliances
is the fact that the fixed appliance needs to beis the fact that the fixed appliance needs to be
placed as a whole, to establish the necessaryplaced as a whole, to establish the necessary
anchorage. Also, control of the vestibular movementanchorage. Also, control of the vestibular movement
of the lower incisors is important. In such cases it isof the lower incisors is important. In such cases it is
sometimes necessary to resort to other anchoragesometimes necessary to resort to other anchorage
appliances. As such, it can be rather difficult to useappliances. As such, it can be rather difficult to use
these appliances in mixed dentition.these appliances in mixed dentition.

THE CALIBRATED FORCETHE CALIBRATED FORCE
MODULEMODULE
It was a fixed appliance designed to substituteIt was a fixed appliance designed to substitute
Class II elastics and it was developed in 1988Class II elastics and it was developed in 1988
by the CorMar Inc. Available in three sizes, itby the CorMar Inc. Available in three sizes, it
was applied to the inferior arch close to thewas applied to the inferior arch close to the
molars and fixed by a screw, and mesial ormolars and fixed by a screw, and mesial or
distal to upper cuspids, and also fixed to thedistal to upper cuspids, and also fixed to the
arch. Its coil spring produced a force betweenarch. Its coil spring produced a force between
150 and 200 gm .150 and 200 gm .

CALIBERATED FORCECALIBERATED FORCE
MODULEMODULE

The same company proposed a HerbstThe same company proposed a Herbst
appliance with an exterior coil spring,appliance with an exterior coil spring,
attached to the inferior tube. That systemattached to the inferior tube. That system
generated tooth movement by employinggenerated tooth movement by employing
gentle and continuous force 24 hours agentle and continuous force 24 hours a
day .day .

HERBST WITH FORCEHERBST WITH FORCE
MODULEMODULE

EUREKA SPRINGEUREKA SPRING
This appliance appeared on the market inThis appliance appeared on the market in
1996 and it was developed by DeVicenzo1996 and it was developed by DeVicenzo
and Steve Prins . It is a three partand Steve Prins . It is a three part
telescopic appliance fixed to the uppertelescopic appliance fixed to the upper
arch at the level of the molar band and toarch at the level of the molar band and to
the lower arch distal to the cuspid. Thethe lower arch distal to the cuspid. The
appliance has an open coil spring that isappliance has an open coil spring that is
placed inside of a part of the system.placed inside of a part of the system.

Interestingly the authors caution in theInterestingly the authors caution in the
manual that the appliance does not createmanual that the appliance does not create
any orthopedic effect, but underline that theany orthopedic effect, but underline that the
correction is totally dentoalveolar.correction is totally dentoalveolar.
The placement system is relatively simple,The placement system is relatively simple,
and the patient can open his or her mouthand the patient can open his or her mouth
widely without any difficulties due to thewidely without any difficulties due to the
telescopic effect of the appliance. It istelescopic effect of the appliance. It is
available in two sizes: 20 and 23 mm long.available in two sizes: 20 and 23 mm long.
The appliance is universal and it can beThe appliance is universal and it can be
applied both to the right as well as to theapplied both to the right as well as to the
left side .left side .

EUREKA SPRINGEUREKA SPRING

THE TWIN FORCE BITETHE TWIN FORCE BITE
CORRECTORCORRECTOR
This appliance differs from others in form andThis appliance differs from others in form and
constitution because it has two internal coilconstitution because it has two internal coil
springs. It consists of two joint telescopicsprings. It consists of two joint telescopic
systems. At the superior level it is fixed with asystems. At the superior level it is fixed with a
ball pin that is fitted into the buccal tube of aball pin that is fitted into the buccal tube of a
molar band. The placement in the lower archmolar band. The placement in the lower arch
is slightly different; it involves a fitting-inis slightly different; it involves a fitting-in
system that is later fixed with a screw to thesystem that is later fixed with a screw to the
inferior arch. Normally it is placed distal to theinferior arch. Normally it is placed distal to the
lower cuspid.lower cuspid. www.indiandentalacademy.comwww.indiandentalacademy.com

Generally this type of fixing allows for rapidGenerally this type of fixing allows for rapid
placement and removal of the appliance. It isplacement and removal of the appliance. It is
available in two sizes and accompanied by aavailable in two sizes and accompanied by a
screwdriver to fix the screw in the lower arch.screwdriver to fix the screw in the lower arch.
Such as in the previous appliance itsSuch as in the previous appliance its
application vary between Class II and Classapplication vary between Class II and Class
III treatment, and it may be also used as anIII treatment, and it may be also used as an
anchorage system.anchorage system.

Due to its original configuration, theseDue to its original configuration, these
appliances are suitable for cases where thereappliances are suitable for cases where there
is a need to carry out correction that requiresis a need to carry out correction that requires
predominantly dentoalveolar movement. Inpredominantly dentoalveolar movement. In
order to avoid protrusion of the lower incisorsorder to avoid protrusion of the lower incisors
it is recommended to use stronger steel wiresit is recommended to use stronger steel wires
or to resort to other accessories.or to resort to other accessories.
The major drawback of this appliance is theThe major drawback of this appliance is the
difficulty to control the force. If we want lessdifficulty to control the force. If we want less
force, we should bend the mesial part of theforce, we should bend the mesial part of the
ball pin in order to have more wire distal to theball pin in order to have more wire distal to the
tube. This situation, however, may createtube. This situation, however, may create
discomfort and impingement problemsdiscomfort and impingement problemswww.indiandentalacademy.comwww.indiandentalacademy.com

The other disadvantage lies in the fact that theThe other disadvantage lies in the fact that the
lower the lower dentition needs to be alreadylower the lower dentition needs to be already
aligned as it is recommended to usealigned as it is recommended to use
016"x.022, or 017"x.025" stainless steel wires016"x.022, or 017"x.025" stainless steel wires
that guarantee necessary anchorage. In thisthat guarantee necessary anchorage. In this
way the device is in principle recommendedway the device is in principle recommended
for permanent dentition.for permanent dentition.
For Class III correction it is necessary to put aFor Class III correction it is necessary to put a
lip bumper tube (LBT) on the lower molarlip bumper tube (LBT) on the lower molar
band.band.

Recently the third modernized version of theRecently the third modernized version of the
appliance has been presented under theappliance has been presented under the
name "Twin Force Bite Corrector – Doublename "Twin Force Bite Corrector – Double
Lock" . It is reduced in size and both theLock" . It is reduced in size and both the
lower and upper placement is based on thelower and upper placement is based on the
system of lock-on screws. This new versionsystem of lock-on screws. This new version
facilitates the use of the appliance for Classfacilitates the use of the appliance for Class
III correction and it allows for a slightly betterIII correction and it allows for a slightly better
control of the force although it still falls shortcontrol of the force although it still falls short
of the full control.of the full control.

TWIN FORCE BITETWIN FORCE BITE
CORRECTORCORRECTOR

FORSUSFORSUS
FATIGUE RESISTANT DEVICEFATIGUE RESISTANT DEVICE
This is an innovative three telescopic appliance withThis is an innovative three telescopic appliance with
a coil spring in its exterior part. This feature makesa coil spring in its exterior part. This feature makes
it resemble some flexible functional appliancesit resemble some flexible functional appliances
(AFF).(AFF).
In comparison with AFF its great advantage lies inIn comparison with AFF its great advantage lies in
coil spring resistance to breaking. The coil spring iscoil spring resistance to breaking. The coil spring is
applied by its sliding on a rigid surface avoiding inapplied by its sliding on a rigid surface avoiding in
this way angulations at the fixing points.this way angulations at the fixing points.
It is sold in kits that include different length sizes forIt is sold in kits that include different length sizes for
left and right sideleft and right side www.indiandentalacademy.comwww.indiandentalacademy.com

In the original presentation the appliance is placed inIn the original presentation the appliance is placed in
the mandible on the round-segmented arch that isthe mandible on the round-segmented arch that is
included in the kit. The appliance slides along the archincluded in the kit. The appliance slides along the arch
and facilitates opening of the mouth and lateraland facilitates opening of the mouth and lateral
movements. The resulting force concentrates more onmovements. The resulting force concentrates more on
the anterior and inferior sectors.the anterior and inferior sectors.
In this way there is no interference with continuousIn this way there is no interference with continuous
arches used during the treatment, which offers widearches used during the treatment, which offers wide
application independently of the method applied.application independently of the method applied.
The appliance may be fixed in various ways accordingThe appliance may be fixed in various ways according
to the needs of the patientto the needs of the patient

The device gives the power to control theThe device gives the power to control the
amount of force, whether through variousamount of force, whether through various
available sizes, or through the directavailable sizes, or through the direct
attachment to the lower arch and the use ofattachment to the lower arch and the use of
a stop for activation. Thus the appliance maya stop for activation. Thus the appliance may
be used in cases of mixed dentition and itbe used in cases of mixed dentition and it
allows for dental asymmetry correction whenallows for dental asymmetry correction when
higher force on both sides is needed.higher force on both sides is needed.
The device allows patient to open and moveThe device allows patient to open and move
their jaw freely.their jaw freely.

Copy of 21

Recommended

Recommended

More Related Content

What's hot

What's hot (20)

Similar to Copy of 21

Similar to Copy of 21 (20)

More from Indian dental academy

More from Indian dental academy (20)

Recently uploaded

Recently uploaded (20)

Copy of 21