Fixed Functional Appliances Guide

FIXEDFIXED
FUNCTIONALFUNCTIONAL
APPLIANCESAPPLIANCES
www.indiandentalacademy.comwww.indiandentalacademy.com

CONTENTSCONTENTS
 INTRODUCTION.INTRODUCTION.
 HISTORY & EVOLUTION OF FUNCTIONALHISTORY & EVOLUTION OF FUNCTIONAL
APPLIANCESAPPLIANCES
 CLSSIFICATION OF FIXED FUNCTIONALCLSSIFICATION OF FIXED FUNCTIONAL
APPLIANCES.APPLIANCES.
 PRINCIPLES OF FUNCTIONAL APPLIANCES.PRINCIPLES OF FUNCTIONAL APPLIANCES.

 FIXED FUNCTIONAL APPLIANCES.FIXED FUNCTIONAL APPLIANCES.
1.1. HERBST APPLIANCESHERBST APPLIANCES
2.2. JASPER JUMPERJASPER JUMPER
3.3. MANDIBULAR PROTRACTION APPLIANCEMANDIBULAR PROTRACTION APPLIANCE
4.4. MARS APPLIANCEMARS APPLIANCE
5.5. ADJUSTABLE BITE CORRECTORADJUSTABLE BITE CORRECTOR
6.6. THE CHURRO JUMPERTHE CHURRO JUMPER
7.7. EUREKA SPRINGEUREKA SPRING
8.8. RICK-E –NATOR.RICK-E –NATOR.
9.9. THE KLAPPER SUPER SPRINGTHE KLAPPER SUPER SPRING
10.10. THE BITE FIXERTHE BITE FIXER
11.11. THE MAGNETIC TELESCOPIC DEVICETHE MAGNETIC TELESCOPIC DEVICE

 CASE PRESENTATIONCASE PRESENTATION
 CONCLUSIONCONCLUSION
 BIBLIOGRAPHYBIBLIOGRAPHY

INTRODUCTIONINTRODUCTION

Orthodontics as a science evolved on theOrthodontics as a science evolved on the
pertext of giving a person maximal, optimalpertext of giving a person maximal, optimal
treatment.treatment.
The basis being improvement in diagnosis &The basis being improvement in diagnosis &
mechanotherapy , all along an essentialmechanotherapy , all along an essential
distinction exists between the termsdistinction exists between the terms
““ORTHODONTICSORTHODONTICS” & “” & “DENTOFACIALDENTOFACIAL
ORTHOPEDICS”.ORTHOPEDICS”.

They represent a fundamental variance in theThey represent a fundamental variance in the
approach to correction of dentofacialapproach to correction of dentofacial
abnormalities .abnormalities .
By definitionBy definition ORTHODONTICORTHODONTIC treatment aimstreatment aims
toto correct the dental irregularitiescorrect the dental irregularities..

The alternative termThe alternative term DENTAL ORTHOPEDICSDENTAL ORTHOPEDICS ––
suggested by SIR NORMAN BENNET andsuggested by SIR NORMAN BENNET and
although this is a wider definition than orthodonticsalthough this is a wider definition than orthodontics
but still does not convey the objective ofbut still does not convey the objective of
improving facial development.improving facial development.
The broader description of dentofacial orthopedicsThe broader description of dentofacial orthopedics
conveys the concept that the treatment aims toconveys the concept that the treatment aims to
improve not onlyimprove not only dentaldental && orthopedicorthopedic relationshipsrelationships
in the stomatognathic system but alsoin the stomatognathic system but also facialfacial
balance.balance.

WHAT AREWHAT ARE
FUNCTIONALFUNCTIONAL
APPLIANCES ?APPLIANCES ?

Functional appliancesFunctional appliances
formform
the most interesting,the most interesting,
fascinating part offascinating part of
mechanotherapeuticmechanotherapeutic
armamentariumarmamentarium
available to anavailable to an
orthodontist.orthodontist.

 Myofunctional appliances.Myofunctional appliances.
 Functional appliances.Functional appliances.

 Functional appliances are those appliancesFunctional appliances are those appliances
thatthat elicitelicit certaincertain natural functionsnatural functions ofof
orofacial musculature & effect changes.orofacial musculature & effect changes.
 Myofunctional appliances are those whichMyofunctional appliances are those which
harness the muscle pressureharness the muscle pressure to theirto their
advantage & thereby affect the toothadvantage & thereby affect the tooth
movement.movement.

HISTORY & EVOLUTION OFHISTORY & EVOLUTION OF
FUNCTIONAL APPLIANCESFUNCTIONAL APPLIANCES

From late 17From late 17thth
century till date functionalcentury till date functional
appliance philosophy & practice have beenappliance philosophy & practice have been
modulated several times, with advance inmodulated several times, with advance in
the basic biologic research, much light hasthe basic biologic research, much light has
been shed on the dark corners of –been shed on the dark corners of –
Why !Why !
How !How !
of functional appliance therapy.of functional appliance therapy.

Functional & Myofunctional appliances haveFunctional & Myofunctional appliances have
enjoyed almost 100 years of activeenjoyed almost 100 years of active
existence, these years have not alwaysexistence, these years have not always
been smooth, but have been turbid at times.been smooth, but have been turbid at times.
It is these turbid years which have led toIt is these turbid years which have led to
immense progress & understanding that weimmense progress & understanding that we
have of these appliances today.have of these appliances today.

 Treatment modalities by these appliances &Treatment modalities by these appliances &
the associated research findings havethe associated research findings have
necessitated a new terminology innecessitated a new terminology in
orthodontic lexicon-orthodontic lexicon-
Dentofacial jaw orthopedicsDentofacial jaw orthopedics oror
Functional jaw orthopedics..
From the simplest inclined planes to theFrom the simplest inclined planes to the
modern day fixed functional appliances.modern day fixed functional appliances.

In earlier days the terms myofunctionalIn earlier days the terms myofunctional
appliances & functional appliances hadappliances & functional appliances had
been used synonymously.been used synonymously.
One of the greatest drawbacks to thisOne of the greatest drawbacks to this
modality of orthodontic treatment has beenmodality of orthodontic treatment has been
extreme “extreme “dogmatismdogmatism” propounded by earlier” propounded by earlier
workers .workers .

So many new systems of appliances cameSo many new systems of appliances came
into being, that the clinicians were atinto being, that the clinicians were at
crossroads to choose the right appliance,crossroads to choose the right appliance,
hence they resorted to a “hence they resorted to a “follow the leaderfollow the leader””
approach. The reasons for such anapproach. The reasons for such an
approach were –approach were –
1) Absence of any scientific basis ,or any1) Absence of any scientific basis ,or any
data as regards to diagnosis, casedata as regards to diagnosis, case
selection, appliance action etc.selection, appliance action etc.

Hence each appliance had unique attributesHence each appliance had unique attributes
which worked best in the hands of thewhich worked best in the hands of the
innovator who then formed his own rules &innovator who then formed his own rules &
dictums, largely on clinical impressions.dictums, largely on clinical impressions.
2) Clinicians found it much easier to allow the2) Clinicians found it much easier to allow the
appliance to dictate their diagnosis ratherappliance to dictate their diagnosis rather
than undertake the arduous task of affectingthan undertake the arduous task of affecting
a comprehensive diagnosis.a comprehensive diagnosis.

3) Poor knowledge & understanding of3) Poor knowledge & understanding of
growth biology & lack of ability to utilizegrowth biology & lack of ability to utilize
growth to its advantage were stronggrowth to its advantage were strong
contributory factors.contributory factors.
Over a period of time this had ledOver a period of time this had led
to spotty results , frustration & subsequentto spotty results , frustration & subsequent
rejectionrejection of functional appliances.of functional appliances.

Generalizing an appliance , for all types ofGeneralizing an appliance , for all types of
malocclusion or for a particularmalocclusion or for a particular
malocclusion in different individuals was themalocclusion in different individuals was the
recourse taken by dogmatic advocates ofrecourse taken by dogmatic advocates of
functional appliances .functional appliances .
Thus the important aspect of orthodonticThus the important aspect of orthodontic
diagnosisdiagnosis was overlooked or underplayed.was overlooked or underplayed.

As such poor or unfavourable response to functionalAs such poor or unfavourable response to functional
appliances can be summarized as-appliances can be summarized as-
 Excessive use.Excessive use.
 Poor or wrong diagnosis.Poor or wrong diagnosis.
 Inadequate training.Inadequate training.
 Poor knowledge of growth.Poor knowledge of growth.
 poor patient co-operation.poor patient co-operation.
 Poor patient selection.Poor patient selection.
 Poor fabrication.Poor fabrication.
 Improper bite registration.Improper bite registration.
 Impatience of orthodontist.Impatience of orthodontist.

Four famous men who came forward with thisFour famous men who came forward with this
fundamentally new approach to orthodonticfundamentally new approach to orthodontic
treatment –treatment –
Norman .w. Kingsley –Norman .w. Kingsley –
was the first to use the forwardwas the first to use the forward
positioning of the mandible in orthodontic therapy.positioning of the mandible in orthodontic therapy.
Pierre RobinPierre Robin ––
first to design a type of appliance that wasfirst to design a type of appliance that was
later used to influence muscular activity by thelater used to influence muscular activity by the
change in spatial relationship of jaws.change in spatial relationship of jaws.

Alfred .p. Rogers-Alfred .p. Rogers-
who recognized the importance of thewho recognized the importance of the
whole orofacial system in the problems ofwhole orofacial system in the problems of
orthodontic treatment.orthodontic treatment.
Viaggo Andresen –Viaggo Andresen –
who took the decisive step of designing forwho took the decisive step of designing for
the treatment of malocclusion -the treatment of malocclusion -
An alert appliance that fitted loosely in the mouth &An alert appliance that fitted loosely in the mouth &
by its mobility transferred muscular stimuli to theby its mobility transferred muscular stimuli to the
jaws, teeth , & supporting structures.jaws, teeth , & supporting structures.

Kingsley in 1879Kingsley in 1879
described the bite plane he haddescribed the bite plane he had
designed. It was adapted to the upper archdesigned. It was adapted to the upper arch
& the inclined surface projected below && the inclined surface projected below &
caught the lower incisors. The objective wascaught the lower incisors. The objective was
not to protrude the lower incisors but tonot to protrude the lower incisors but to
jump the bite in case of an excessivelyjump the bite in case of an excessively
retruded lower jaw.retruded lower jaw.

Edward . H Angle –Edward . H Angle –
gave a sliding device whichgave a sliding device which
generally fitted to upper & lower 1generally fitted to upper & lower 1stst
molars &molars &
named it as “ the plane & spur retention.”named it as “ the plane & spur retention.”

Rudolf hotz –Rudolf hotz –
devised a guide plate which wasdevised a guide plate which was
attached to upper arch ,because of theattached to upper arch ,because of the
inclined planes the lower teeth & theinclined planes the lower teeth & the
mandible were positioned forward.mandible were positioned forward.

A.M Schwarz –A.M Schwarz –
recommended crowns on the upper &recommended crowns on the upper &
lower second deciduous molars, & called itlower second deciduous molars, & called it
“VORBISSKRONEN” a cone on the upper“VORBISSKRONEN” a cone on the upper
crown – forced class II div. I into a class Icrown – forced class II div. I into a class I
dentition.dentition.

A massive pin & tube sliding devise of HERBST wasA massive pin & tube sliding devise of HERBST was
very popular in Europe , & has been brought backvery popular in Europe , & has been brought back
into use by Pancherz, McNamara & others.into use by Pancherz, McNamara & others.
Meanwhile Frankel, Harvold ,Wieslander & othersMeanwhile Frankel, Harvold ,Wieslander & others
were showing that mandibular repositioningwere showing that mandibular repositioning
appliance could reliably & permanently move theappliance could reliably & permanently move the
mandible forward & that excellent orthodonticmandible forward & that excellent orthodontic
results could be achieved.results could be achieved.

Subsequently functional appliances includingSubsequently functional appliances including
the Herbst appliance have assumed a majorthe Herbst appliance have assumed a major
place in contemporary growth modificationplace in contemporary growth modification
procedures.procedures.

CLASSIFICATIONCLASSIFICATION

11stst
classificationclassification ––
All the functional appliances , were groupedAll the functional appliances , were grouped
together, where they were considered to be subtogether, where they were considered to be sub
class of removable appliances.class of removable appliances.

22ndnd
classificationclassification --
Put forth by Dr. Tom Graber (when functional appliancesPut forth by Dr. Tom Graber (when functional appliances
were still removable).were still removable).
Group A – Teeth supported appliances.Group A – Teeth supported appliances.
eg. Catalans, Inclined planes.eg. Catalans, Inclined planes.
Group B – Teeth / Tissue supported appliances.Group B – Teeth / Tissue supported appliances.
eg. Activator , Bionator.eg. Activator , Bionator.
group C – Vestibular positioned appliances.group C – Vestibular positioned appliances.
with isolated support from Teeth/ Tissue.with isolated support from Teeth/ Tissue.
eg. Oral screen , Frankel, Lip bumpers.eg. Oral screen , Frankel, Lip bumpers.

33rdrd
with advent of fixed functional appliancewith advent of fixed functional appliance
a) Removable functionals – Activator ,Frankela) Removable functionals – Activator ,Frankel
b) Semi-fixed functionals – Denholtz, Bassb) Semi-fixed functionals – Denholtz, Bass
appliance.appliance.
c) Fixed functionals – Herbst , Jasper jumper,c) Fixed functionals – Herbst , Jasper jumper,
MARS.MARS.

44thth
Given byGiven by Peter VigPeter Vig
a) Classical functional appliances –a) Classical functional appliances –
eg.Activator,Frankel , Catalans.eg.Activator,Frankel , Catalans.
b) Hybrid appliances like – Propulsor, doubleb) Hybrid appliances like – Propulsor, double
oral screen.oral screen.

Certain functional appliances have undergoneCertain functional appliances have undergone
so much use , study & research over theso much use , study & research over the
time that they themselves demand atime that they themselves demand a
classification system.classification system.
A further dimension of active & passiveA further dimension of active & passive
appliances was incorporated & a newappliances was incorporated & a new
system of classification was advocated.system of classification was advocated.

55thth
Classification –Classification –
1)1) Tooth borne passive appliances- myotonicTooth borne passive appliances- myotonic
eg. Andreson activator , Harren activator ,eg. Andreson activator , Harren activator ,
woodside activator, Balters bionator.woodside activator, Balters bionator.
2) Tooth borne active appliances-myodynamic2) Tooth borne active appliances-myodynamic
eg. Elastic open activator , Bimler applianceeg. Elastic open activator , Bimler appliance
3) Tissue borne passive –3) Tissue borne passive –
eg. Oral screens , lip bumpers.eg. Oral screens , lip bumpers.
4) Tissue borne active –4) Tissue borne active –
eg. Frankeleg. Frankel

66thth
classification –classification –
According to the force producedAccording to the force produced
1)1) Appliances producing pushing force.Appliances producing pushing force.
a) Temporarily fixed functional appliancesa) Temporarily fixed functional appliances
eg. Twin block.eg. Twin block.
b) Permanently fixed functional appliances.b) Permanently fixed functional appliances.
i) Rigid appliances –i) Rigid appliances –
Herbst & its family.Herbst & its family.
Rick-a- nator.Rick-a- nator.
MPAMPA
ii) Flexible appliances –ii) Flexible appliances –
Jasper jumperJasper jumper
Churro jumperChurro jumper
2) Appliances producing pull force2) Appliances producing pull force
eg. SAIF springeg. SAIF spring

77thth
classification –classification –
According to cyber journal of orthodontics.According to cyber journal of orthodontics.
1) Flexible fixed functional appliances.1) Flexible fixed functional appliances.
eg. Jasper jumpereg. Jasper jumper
Churro jumperChurro jumper
2) Rigid fixed functional appliances2) Rigid fixed functional appliances
eg. MPAeg. MPA
Herbst applianceHerbst appliance
3) Hybrid fixed functional appliances3) Hybrid fixed functional appliances
eg. Eureka spring.eg. Eureka spring.

PRINCIPLES OFPRINCIPLES OF
FUNCTIONAL APPLIANCESFUNCTIONAL APPLIANCES..

 Growth utilization.Growth utilization.
 Correct diagnosis.Correct diagnosis.
 Ideal & responsive type of malocclusion.Ideal & responsive type of malocclusion.
 Construction bite.Construction bite.
 Eruptive bite platform.Eruptive bite platform.
 Linguo facial screening.Linguo facial screening.
 Force delivery / Force elimination.Force delivery / Force elimination.
 Patient co – operation.Patient co – operation.
 Patience.Patience.
 Component or tailor made approach rather than generic.Component or tailor made approach rather than generic.

 Growth utilization –Growth utilization –
Growth is a biologic phenomenon , it is Omnipotent,Growth is a biologic phenomenon , it is Omnipotent,
in orthodontics. it has a role in-in orthodontics. it has a role in-
1.1. EtiologyEtiology
2.2. DiagnosisDiagnosis
3.3. Treatment planningTreatment planning
4.4. Treatment &Treatment &
5.5. RetentionRetention
Thus itThus it makesmakes oror breaksbreaks thethe prognosisprognosis of the case.of the case.

Till we comprehend it fully , growth will alwaysTill we comprehend it fully , growth will always
remain anremain an enigmaenigma , & growth related, & growth related
treatment antreatment an intriguingintriguing && fascinatingfascinating
modality.modality.
When we utilize growth , we undertake toWhen we utilize growth , we undertake to
modulate it, an exercise known asmodulate it, an exercise known as growthgrowth
modulation.modulation.

Growth modulation procedures interact withGrowth modulation procedures interact with
basic biologic process ,thereby distributingbasic biologic process ,thereby distributing
the morphologic & functional balance duringthe morphologic & functional balance during
the treatment & interaction period.the treatment & interaction period.
With in a period of time , a new compositeWith in a period of time , a new composite
balance is achieved ,thereby showingbalance is achieved ,thereby showing
altered morphology & function which wealtered morphology & function which we
interpret asinterpret as treatment result.treatment result.

The basic methods of growth modulation areThe basic methods of growth modulation are
as follows –as follows –
1.1. Absolute increase or decrease in size.Absolute increase or decrease in size.
2.2. Acceleration / Retardation of rate of jawAcceleration / Retardation of rate of jaw
growth.growth.
3.3. Reposition / Redirect jaws in space withReposition / Redirect jaws in space with
little to moderate growth effect.little to moderate growth effect.
Functional appliances make use of 2Functional appliances make use of 2ndnd
& 3& 3rdrd
method to effect treatment.method to effect treatment.

Correct diagnosisCorrect diagnosis
if there is 1 thing inif there is 1 thing in
orthodontics which isorthodontics which is
crucial that iscrucial that is
diagnosis a trumpdiagnosis a trump
factor,factor,
But unfortunately it isBut unfortunately it is
poorly understood &poorly understood &
applied.applied.

Qualities of aQualities of a good diagnosisgood diagnosis are –are –
1.1. Patience.Patience.
2.2. Good knowledge of growth.Good knowledge of growth.
3.3. Grasp of biologic concept.Grasp of biologic concept.
4.4. Good / adequate diagnostic records.Good / adequate diagnostic records.
5.5. Clinical sense & acumen.Clinical sense & acumen.
6.6. Artistic perception.Artistic perception.
7.7. Natural assistance from residual growth.Natural assistance from residual growth.
8.8. Function & its response .Function & its response .

 Ideal & responsive type of malocclusion.Ideal & responsive type of malocclusion.
The malocclusion diagnosed is now looked at fromThe malocclusion diagnosed is now looked at from
the following perspective -the following perspective -
1)1) Inherited / genetic morphology with functionalInherited / genetic morphology with functional
adaptation to this morphologyadaptation to this morphology..
These are difficult morphologies to treat by growthThese are difficult morphologies to treat by growth
modulation mechanotherapy.modulation mechanotherapy.
HenceHence dentoalveolar camouflagedentoalveolar camouflage is attempted.is attempted.

2)2) Genetically normal , but local /Genetically normal , but local /
environmental influences cause aberration,environmental influences cause aberration,
to which over a period there is functionalto which over a period there is functional
adaptation.adaptation.
Such malocclusions are treated by eliminatingSuch malocclusions are treated by eliminating
/ reducing the aberrant influence , till such/ reducing the aberrant influence , till such
time , normal adaptations can take over.time , normal adaptations can take over.
Growth modulation procedures areGrowth modulation procedures are
successful.successful.

3)3) Form affected by altered function ofForm affected by altered function of
epigenetic factors.epigenetic factors.
There is homeostasis in the altered form asThere is homeostasis in the altered form as
long as there is no change in the alteredlong as there is no change in the altered
function . Such malocclusions respond bestfunction . Such malocclusions respond best
to growth modulation procedures , whereto growth modulation procedures , where
epigenetic factors are eliminated , newepigenetic factors are eliminated , new
matrix is created & normal function ismatrix is created & normal function is
initiated . Thereby normal form is achieved.initiated . Thereby normal form is achieved.

Differential diagnosis ofDifferential diagnosis of
the malocclusion isthe malocclusion is
carried out, therebycarried out, thereby
identifying the correctidentifying the correct
& responsive& responsive
malocclusion leadingmalocclusion leading
to good treatmentto good treatment
result.result.

Construction biteConstruction bite
It is the displacement of the mandible fromIt is the displacement of the mandible from
rest position, to the predetermined positionrest position, to the predetermined position
that is, treatment goal.that is, treatment goal.
It is presumed that mandible in this newIt is presumed that mandible in this new
working bite position is unstressed & wouldworking bite position is unstressed & would
grow normally.grow normally.

Before registering the construction bite, oneBefore registering the construction bite, one
must evaluate the habitual posture of themust evaluate the habitual posture of the
mandible during closure.mandible during closure.
Backward condylar position with an upward &Backward condylar position with an upward &
backward path of closure & decreasedbackward path of closure & decreased
interocclusal clearance.interocclusal clearance.
These cases respond wellThese cases respond well
to functional appliances.to functional appliances.

Some exhibit a forward condylar position withSome exhibit a forward condylar position with
a downward & forward path of closure witha downward & forward path of closure with
increased interocclusal clearance.increased interocclusal clearance.
These cases show limited response.These cases show limited response.
The construction bite’s vertical / sagittalThe construction bite’s vertical / sagittal
parameter will vary for both the situations.parameter will vary for both the situations.

Eruptive bite platform –Eruptive bite platform –
Also called as bite planes , are along withAlso called as bite planes , are along with
construction bite , an integral part of anyconstruction bite , an integral part of any
functional appliance.functional appliance.
They can be of following types –They can be of following types –
1.1. Acrylic bite platform of variable heights.Acrylic bite platform of variable heights.
2.2. Anterior incisor capping.Anterior incisor capping.
3.3. Inclined planes.Inclined planes.
4.4. Springs , bows or clasps resting on cingulum.Springs , bows or clasps resting on cingulum.
5.5. Wire elements interproximally or occlusally.Wire elements interproximally or occlusally.

Eruptive bite planes achieve –Eruptive bite planes achieve –
Differential eruption of posterior teeth.Differential eruption of posterior teeth.
Differential eruption of anterior teeth.Differential eruption of anterior teeth.
Non eruption of anterior / posterior teeth.Non eruption of anterior / posterior teeth.
Over bite maintenance.Over bite maintenance.
Disocclusion / Disarticulation.Disocclusion / Disarticulation.
Vertical face height can be controlled by biteVertical face height can be controlled by bite
platforms. most importantly it helps to remove theplatforms. most importantly it helps to remove the
regulatory control on mandibular growth & initiatesregulatory control on mandibular growth & initiates
some growth of the mandible.some growth of the mandible.

Linguo facial screeningLinguo facial screening
““Equilibrium theory of tooth position”Equilibrium theory of tooth position”
Growing dentoalveolar respond to hyper / hypoGrowing dentoalveolar respond to hyper / hypo
structures activity of muscles.structures activity of muscles.
disturbs the homeostaticdisturbs the homeostatic
Leading to relationship of tongue &Leading to relationship of tongue &
dentoalveolar moulding in the circumoral musculaturedentoalveolar moulding in the circumoral musculature
direction of hyperactivity.direction of hyperactivity.

Over stretching the screens periosteumOver stretching the screens periosteum
Positioning them at strategic stretch reflexPositioning them at strategic stretch reflex
PositionPosition
Increase in arch Bone appositionIncrease in arch Bone apposition
perimeterperimeter & width.& width. resulting in widerresulting in wider
dental basesdental bases

 Force delivery / Force eliminationForce delivery / Force elimination
Forces can be of 3 types –Forces can be of 3 types –
1.1. Compressive.Compressive.
2.2. Tensile.Tensile.
3.3. Shearing or torsion.Shearing or torsion.
On application of the forces , following reactions areOn application of the forces , following reactions are
obvious-obvious-
 Primary / externalPrimary / external
 Secondary / internalSecondary / internal

Primary reaction –Primary reaction –
It is harnessing forces ofIt is harnessing forces of orofacial musculatureorofacial musculature &&
transmitting them to selected dentoalveolar areastransmitting them to selected dentoalveolar areas
to bring about the desired changes. They may beto bring about the desired changes. They may be
also eliminated.also eliminated.
Secondary reaction –Secondary reaction –
Is a result of strain experienced by the tissue due toIs a result of strain experienced by the tissue due to
external reaction this will bring aboutexternal reaction this will bring about deformation,deformation,
remodeling ,displacementremodeling ,displacement & other alterations of& other alterations of
the osseous tissues.the osseous tissues.

 Compressive forces lead toCompressive forces lead to osteoclasticosteoclastic response.response.
 Tensile forces lead toTensile forces lead to osteoblasticosteoblastic response .response .
 Tension can be more effective than pressure orTension can be more effective than pressure or
compression during the treatment as the Alveolarcompression during the treatment as the Alveolar
bone is more capable of resisting pressure , butbone is more capable of resisting pressure , but
not tension.not tension.
 Choosing the right kind of force system will help inChoosing the right kind of force system will help in
successful appliance design & therapy.successful appliance design & therapy.

Patient co-operation & compliance –Patient co-operation & compliance –
The perceived advantage & disadvantages ofThe perceived advantage & disadvantages of
both the systems i.e compliant or non-both the systems i.e compliant or non-
compliant must be weighed & composed ,compliant must be weighed & composed ,
keeping in mind the optional results.keeping in mind the optional results.

Patience –Patience –
The modality is time consumingThe modality is time consuming
Does not show rapid results or obviousDoes not show rapid results or obvious
tooth movements.tooth movements.
Patients whims & fanciesPatients whims & fancies
Laboratory in adequaciesLaboratory in adequacies
Shortcomings in understanding growthShortcomings in understanding growth
Openness to change or modality.Openness to change or modality.

Component or tailor made approachComponent or tailor made approach
rather than generic approach –rather than generic approach –
This is adopting a component approach, theThis is adopting a component approach, the
essence of the concept of “hybridism”.essence of the concept of “hybridism”.

HERBST APPLIANCEHERBST APPLIANCE

HISTORICAL BACKGROUNDHISTORICAL BACKGROUND
Emil Herbst –Emil Herbst –
In 1905 introduced this appliance atIn 1905 introduced this appliance at
international dental congress in Berlin.international dental congress in Berlin.
In 1934 he presented a series of articles asIn 1934 he presented a series of articles as
“retention joint”.“retention joint”.
After 1934 very little was published on theAfter 1934 very little was published on the
subject & the treatment method was more or lesssubject & the treatment method was more or less
forgotten.forgotten.
Dr. Pancherz in 80’s ignited great interest with hisDr. Pancherz in 80’s ignited great interest with his
rediscovery in Europe.rediscovery in Europe.

A fixed bite jumping appliance.A fixed bite jumping appliance.
A change in the sagittal intermaxillary dentalA change in the sagittal intermaxillary dental
arch relationship by an anteriorarch relationship by an anterior
displacement of the mandible.displacement of the mandible.
The appliance is reported to produce bothThe appliance is reported to produce both
skeletal & dental changes in growingskeletal & dental changes in growing
individuals.individuals.

Diagnostic criteria for selection –Diagnostic criteria for selection –
 Patients with convex profile ,class II skeletal &Patients with convex profile ,class II skeletal &
class II dental.class II dental.
 Mainly with retrognathic mandible & orthognathicMainly with retrognathic mandible & orthognathic
maxilla ( ANB – 5maxilla ( ANB – 500
))
 Positive V.T.OPositive V.T.O
 All first molars & permanent lateral incisors shouldAll first molars & permanent lateral incisors should
be fully erupted.be fully erupted.
 Lower incisors should be upright or even slightlyLower incisors should be upright or even slightly
lingually positioned.lingually positioned.

Cephalometrically –Cephalometrically –
 Favourable y-axis. Average – horizontally growing.Favourable y-axis. Average – horizontally growing.
 Normal naso-labial angle.Normal naso-labial angle.
 Good symphyseal development.Good symphyseal development.
 WITS appraisal of 3mm or greater.WITS appraisal of 3mm or greater.
 Upper incisor to SN plane 92Upper incisor to SN plane 9200
or less.or less.
 Ant. To post.ht. Ratio 63% or more.Ant. To post.ht. Ratio 63% or more.
 Normal lip- chin- throat angle.Normal lip- chin- throat angle.

Functional analysis should be performed toFunctional analysis should be performed to
diagnose –diagnose –
Any lateral shift of the mandible from rest toAny lateral shift of the mandible from rest to
occlusion.occlusion.
To check any functional retrusion of theTo check any functional retrusion of the
mandible.mandible.

Description of the appliance –Description of the appliance –
The appliance can be compared to an artificialThe appliance can be compared to an artificial
joint working between the maxilla &joint working between the maxilla &
mandible.mandible.
A bilateral telescopic mechanism keeps theA bilateral telescopic mechanism keeps the
mandible mechanically in a continuousmandible mechanically in a continuous
anterior jumped position.anterior jumped position.

Each telescopic device consists of – pivotsEach telescopic device consists of – pivots
1.1. A tube ( upper)A tube ( upper)
2.2. A plunger ( lower)A plunger ( lower)
3.3. Two pivots &Two pivots &
4.4. Two screws.Two screws.
TubeTube
screwsscrews
PlungerPlunger

The pivot for the tube is usually soldered toThe pivot for the tube is usually soldered to
the permanent maxillary 1the permanent maxillary 1stst
molar band.molar band.
The pivot for plunger to the mandibular 1The pivot for plunger to the mandibular 1stst
premolar band.premolar band.
The screws prevent the telescopic partsThe screws prevent the telescopic parts
from slipping off the pivots.from slipping off the pivots.
The length of the tube determines theThe length of the tube determines the
amount of of advancement.( bite jumping)amount of of advancement.( bite jumping)

The length of the plunger is kept to maximumThe length of the plunger is kept to maximum
to prevent it from slipping out of the tubeto prevent it from slipping out of the tube
when the mouth is opened wide.when the mouth is opened wide.
 If the plunger is too long , however it mayIf the plunger is too long , however it may
protrude far behind the tube & injure theprotrude far behind the tube & injure the
buccal mucosa distal to upper 1buccal mucosa distal to upper 1stst
molar.molar.
To permit the lateral movements it may beTo permit the lateral movements it may be
necessary to widen the pivot opening.necessary to widen the pivot opening.

AnchorageAnchorage
Partial anchorage –Partial anchorage –
 Maxillary archMaxillary arch
Usually 1Usually 1stst
molar & premolars are banded & aremolar & premolars are banded & are
interconnected on each side with half roundinterconnected on each side with half round
,lingual or buccal sectional wire.,lingual or buccal sectional wire.
 Mandibular archMandibular arch
The 1The 1stst
premolars are banded & connected with apremolars are banded & connected with a
half round lingual sectional wire touching thehalf round lingual sectional wire touching the
lingual aspect of anterior teeth.lingual aspect of anterior teeth.
Usually this kind of anchorage is insufficientUsually this kind of anchorage is insufficient

Total anchorageTotal anchorage
 MaxillaryMaxillary
A labial arch wire is ligated to the brackets on the 1A labial arch wire is ligated to the brackets on the 1stst
premolars canines & incisor teeth.premolars canines & incisor teeth.
 MandibularMandibular
The lingual sectional archwire can be extended toThe lingual sectional archwire can be extended to
the permanent 1the permanent 1stst
molars which are banded.molars which are banded.
This increases the anchorage by incorporation ofThis increases the anchorage by incorporation of
additional dental units.additional dental units.

In mixed dentition cases , the deciduous molarsIn mixed dentition cases , the deciduous molars
have to be banded along with 1have to be banded along with 1stst
permanentpermanent
molars.molars.
In the deciduous or early mixed dentition , bondedIn the deciduous or early mixed dentition , bonded
type of Herbst appliance may be used because oftype of Herbst appliance may be used because of
absence of 1absence of 1stst
premolars.premolars.
This system is calledThis system is called splint anchorage systemsplint anchorage system..
According to Raffaele, when possible it may beAccording to Raffaele, when possible it may be
preferred to anchor Herbst mechanism with bandspreferred to anchor Herbst mechanism with bands
that allow tooth eruption during treatment.that allow tooth eruption during treatment.

Disadvantage of the splint anchorage systemDisadvantage of the splint anchorage system
Tooth eruption & interocclusal adjustmentsTooth eruption & interocclusal adjustments
during the treatment are prevented. thisduring the treatment are prevented. this
makes it necessary to use an occlusalmakes it necessary to use an occlusal
stabilization treatment phases after splintsstabilization treatment phases after splints
are removed.are removed.
Unhygienic , high risk of decalcification ofUnhygienic , high risk of decalcification of
tooth structure, if oral hygiene is nottooth structure, if oral hygiene is not
maintained.maintained.

Hans , Pancherz, & ken recommendedHans , Pancherz, & ken recommended
modifications in the mandibular anchoragemodifications in the mandibular anchorage
systems as needed –systems as needed –
Premolar anchoragePremolar anchorage ––
The 1The 1stst
premolars are banded & connectedpremolars are banded & connected
with the lingual sectional archwire touchingwith the lingual sectional archwire touching
the lingual surfaces front teeth ( partialthe lingual surfaces front teeth ( partial
anchorage ).anchorage ).

Premolar – molar anchorage –Premolar – molar anchorage –
11stst
premolars & 1premolars & 1stst
premolars are banded &premolars are banded &
connected with a lingual wire touching the lingualconnected with a lingual wire touching the lingual
surface of the front teeth (total anchorage)surface of the front teeth (total anchorage)
Pellot anchorage –Pellot anchorage –
11stst
premolar & 1premolar & 1stst
molars are banded & connectedmolars are banded & connected
with a lingual arch wire , with the lingual archwireswith a lingual arch wire , with the lingual archwires
acrylic pellot is fabricated & fixed touching theacrylic pellot is fabricated & fixed touching the
lingual mucosa about 3mm below the gingivallingual mucosa about 3mm below the gingival
margin.margin.
ulceration is the major disadvantage.ulceration is the major disadvantage.

Labio – lingual anchorage –Labio – lingual anchorage –
A premolar to premolar labial rectangular archwire isA premolar to premolar labial rectangular archwire is
fixed to the lingual premolar – molar anchoragefixed to the lingual premolar – molar anchorage
system.system.
Class III elastics –Class III elastics –
Class III elastics is used with lingual premolar molarClass III elastics is used with lingual premolar molar
anchorage system.anchorage system.
Pellot – most efficient.Pellot – most efficient.
Labio – lingual anchorage is recommended.Labio – lingual anchorage is recommended.

The construction bite –The construction bite –
Edge to edge incisor relation.Edge to edge incisor relation.
Important considerations in appliance construction –Important considerations in appliance construction –
 Bands should be formed – better than pre formedBands should be formed – better than pre formed
bands.bands.
 Upper & lower pivots should be placed parallel toUpper & lower pivots should be placed parallel to
each other.each other.
 This provides a correct & smooth functioning ofThis provides a correct & smooth functioning of
telescopic mechanism.telescopic mechanism.

 The upper pivot should be placedThe upper pivot should be placed distallydistally on theon the
molar band & lower pivotmolar band & lower pivot mesiallymesially on the premolaron the premolar
band.band.
 A large inter inter pivot distance on each side willA large inter inter pivot distance on each side will
prevent the plunger fromprevent the plunger from slippingslipping out of the tubeout of the tube
when the mouth is opened wide.when the mouth is opened wide.
 Pivot openings should be widened to increase thePivot openings should be widened to increase the
lateral movementlateral movement capacity of the mandible.capacity of the mandible.
 Load on the anchorage teeth during mandibularLoad on the anchorage teeth during mandibular
lateral excursions will be reduced.lateral excursions will be reduced.

Types of appliancesTypes of appliances
 Bonded Herbst appliance.Bonded Herbst appliance.
 Banded Herbst appliance.Banded Herbst appliance.
Bonded Herbst applianceBonded Herbst appliance ––
a) Maxillary wire framework-a) Maxillary wire framework-
.045” chrome-cobalt wire is bent around premolars &.045” chrome-cobalt wire is bent around premolars &
molars both on buccal & lingual side , a transmolars both on buccal & lingual side , a trans
palatal bar is included in the design to increasepalatal bar is included in the design to increase
stability.stability.
Wire is kept 1 mm away from the tooth surface justWire is kept 1 mm away from the tooth surface just
above the gingival margin. Wire rests may beabove the gingival margin. Wire rests may be
placed on occlusal surface of 2placed on occlusal surface of 2ndnd
premolars topremolars to
prevent theirprevent their supraeruption.supraeruption.

b) Mandibular wire frame work –b) Mandibular wire frame work –
.040 elgiloy wire is used & it is contoured.040 elgiloy wire is used & it is contoured
along the lingual surfaces of six anterioralong the lingual surfaces of six anterior
teeth & posterior teeth .teeth & posterior teeth .
After making the framework splint is fabricatedAfter making the framework splint is fabricated
using biostar & then it is bonded.using biostar & then it is bonded.

Banded Herbst appliance –Banded Herbst appliance –
 0.15mm thick band material is used to band0.15mm thick band material is used to band
the upper 1the upper 1stst
molars & lower premolars &molars & lower premolars &
molars.molars.
Bite registration is carried out.Bite registration is carried out.
Wire framework is made & soldered to theWire framework is made & soldered to the
bandsbands
Before cementing the bands, tubes &Before cementing the bands, tubes &
plungers are fittedplungers are fitted

Following points are checked -Following points are checked -
Facial midline alignment.Facial midline alignment.
Proper mandibular advancement.Proper mandibular advancement.
Parallelism of tubes & arms to the pivot.Parallelism of tubes & arms to the pivot.
Ease of opening.Ease of opening.
Lateral movements.Lateral movements.
Necessary adjustments are made & thenNecessary adjustments are made & then
appliance is cemented.appliance is cemented.

Problems –Problems –
1.1. Banded Herbst appliance-Banded Herbst appliance-
Breakage & loose bands soBreakage & loose bands so LangfordLangford suggestedsuggested
use of stainless steel crowns to overcome thisuse of stainless steel crowns to overcome this
problem.problem.
2. Bonded Herbst appliance-2. Bonded Herbst appliance-
-It is unhygienic as it is difficult to maintain hygiene,-It is unhygienic as it is difficult to maintain hygiene,
decalcification & decay are commonly seen .decalcification & decay are commonly seen .
-It can create posterior openbite which needs-It can create posterior openbite which needs
correction later.correction later.

Modification in appliance design & additionModification in appliance design & addition
of auxiliary –of auxiliary –
In class II with a narrow & constrictedIn class II with a narrow & constricted
maxillary dental arch, posterior cross bite-maxillary dental arch, posterior cross bite-
Expansion can be performed by soldering aExpansion can be performed by soldering a
quad helix or other rapid palatal expansionquad helix or other rapid palatal expansion
device to premolar & molar bands.device to premolar & molar bands.

 If mandibular 1If mandibular 1stst
premolars have not erupted thepremolars have not erupted the
permanent canines can be used for anchorage.permanent canines can be used for anchorage.
Care should be taken, as the buccal mucosa atCare should be taken, as the buccal mucosa at
the corner of mouth is prone for ulceration whenthe corner of mouth is prone for ulceration when
canine is used as anchor.canine is used as anchor.
 Buccal tubes can be welded to mandibular 1Buccal tubes can be welded to mandibular 1stst
molar,which can be used to engage lip bumper tomolar,which can be used to engage lip bumper to
correct hyper active mentalis associated with classcorrect hyper active mentalis associated with class
II malocclusion & also provide distal component ofII malocclusion & also provide distal component of
force to mandibular arch to minimize the dentalforce to mandibular arch to minimize the dental
changes.changes.

In cases of patients with vertical hyperplasiaIn cases of patients with vertical hyperplasia
of the lower face , vertical pull chin cup canof the lower face , vertical pull chin cup can
be used along with Herbst appliance.be used along with Herbst appliance.
(Raymond .p Howe).(Raymond .p Howe).
Lennart weislanderLennart weislander
 suggested use of a high pull headgear withsuggested use of a high pull headgear with
Herbst appliance.Herbst appliance.

To decrease the breakage problem with bandedTo decrease the breakage problem with banded
Herbst appliance is modified & called asHerbst appliance is modified & called as EmdenEmden
modification making the appliance more durablemodification making the appliance more durable
simple & hygienic.simple & hygienic.
 Stainless steel crowns on 1Stainless steel crowns on 1stst
permanent molars.permanent molars.
 Removable acrylic splint on the mandibular arch.Removable acrylic splint on the mandibular arch.
 Double buccal tubes on the molars which canDouble buccal tubes on the molars which can
accomodate utility arches, sectional or continuousaccomodate utility arches, sectional or continuous
wires.wires.

It reduces the possibility of decalcificationIt reduces the possibility of decalcification
beneath the appliance.beneath the appliance.
Further the retention can be addedFurther the retention can be added
mechanically by sandblasting the inner ofmechanically by sandblasting the inner of
the crown with a microetcher.the crown with a microetcher.
Glass ionomer is the ideal material forGlass ionomer is the ideal material for
retaining Herbst appliance.retaining Herbst appliance.

Treatment effect on the dentofacial complex –Treatment effect on the dentofacial complex –
Lot of research by authors like Hans Pancherz, KenLot of research by authors like Hans Pancherz, Ken
Hansen, Lennart Weislander , James McNamara,Hansen, Lennart Weislander , James McNamara,
Raymond .p Howehas revealed the effect of theRaymond .p Howehas revealed the effect of the
Herbst appliance.Herbst appliance.
 The appliance had a restraining effect on theThe appliance had a restraining effect on the
maxillary growth.maxillary growth.
 Stimulating effect on the mandibular growth.Stimulating effect on the mandibular growth.
Pancherz ( 1979) (Hagg, Pancherz 1985 , 1988)Pancherz ( 1979) (Hagg, Pancherz 1985 , 1988)

Clinically class I molar relation was achievedClinically class I molar relation was achieved
probably due toprobably due to
 An increase in the mandibular length.An increase in the mandibular length.
 Distal movement of the maxillary molars.Distal movement of the maxillary molars.
 Mesial movement of the mandibular molars.Mesial movement of the mandibular molars.
A decrease in the overjet & overbite wasA decrease in the overjet & overbite was
observed probably because ofobserved probably because of
 Increase in mandibular length.Increase in mandibular length.
 Labial movement of mandibular incisors resultingLabial movement of mandibular incisors resulting
in opening of bite.in opening of bite.
Extensive dental changes occur in the maxilla & theExtensive dental changes occur in the maxilla & the
mandible during the therapy. (Panchez 1982),mandible during the therapy. (Panchez 1982),
( Pancherz & Hansen 1986)( Pancherz & Hansen 1986)

Advantages –Advantages –
 Continuous action.Continuous action.
 Short duration of the treatment.Short duration of the treatment.
 Less patient co-operation needed.Less patient co-operation needed.
 step wise advancement can be carried out.step wise advancement can be carried out.
 It can be used in patients with nasal airwayIt can be used in patients with nasal airway
obstruction, where proper use of the removableobstruction, where proper use of the removable
appliances become impossible.appliances become impossible.
 In post adolescent patients – treatment finished inIn post adolescent patients – treatment finished in
6-8 months thus making it possible to use residual6-8 months thus making it possible to use residual
growth left in patients.growth left in patients.
 Rapid maxillary expansion can be carried outRapid maxillary expansion can be carried out
along with Herbst appliance in cases of posterioralong with Herbst appliance in cases of posterior
cross bite.cross bite.

Disadvantages –Disadvantages –
 There is increased risk of development of dual biteThere is increased risk of development of dual bite
with dysfunction symptoms from TMJ as possiblewith dysfunction symptoms from TMJ as possible
consequence.consequence.
 Repeated breakage & loosening of the appliance –Repeated breakage & loosening of the appliance –
which can be handled by using crowns.which can be handled by using crowns.
 Tendency of posterior open bite.Tendency of posterior open bite.
 Like any other functional appliance it also requiresLike any other functional appliance it also requires
some amount of patient co –operation as initialsome amount of patient co –operation as initial
discomfort is usually present.discomfort is usually present.

Rapid intrusion of mandibular 1Rapid intrusion of mandibular 1stst
bicuspids,bicuspids,
even this condition is temporary.even this condition is temporary.
Plaque accumulation & decalcificationPlaque accumulation & decalcification
occurs especially in a splint type.occurs especially in a splint type.

ContraindicationContraindication for Herbst appliancefor Herbst appliance ––
Non growing subject.Non growing subject.
Hyperdivergent facial pattern.Hyperdivergent facial pattern.
Abnormal mid face.Abnormal mid face.
Negative V.T.O.Negative V.T.O.

Instruction to the patient –Instruction to the patient –
Patient should report immediately if anyPatient should report immediately if any
damage occurs.damage occurs.
Patient should have soft diet for about aPatient should have soft diet for about a
week.week.
Patient should be informed about ulcers ,Patient should be informed about ulcers ,
muscle pain, & general discomfort.muscle pain, & general discomfort.
Patient should be advised to take care ofPatient should be advised to take care of
oral hygiene & fluoride rinsing.oral hygiene & fluoride rinsing.

Retention after Herbst applianceRetention after Herbst appliance
treatment.treatment.
The improvement in the sagittal direction seenThe improvement in the sagittal direction seen
during the treatment is mainly a result ofduring the treatment is mainly a result of
 Increase in the mandibular growth.Increase in the mandibular growth.
 Distal tooth movement in the maxilla &Distal tooth movement in the maxilla &
mesial tooth movement in the mandible.mesial tooth movement in the mandible.
Unfavourable growth , unstable occlusalUnfavourable growth , unstable occlusal
relationships, oral habits that persist afterrelationships, oral habits that persist after
treatment are potential risk factors fortreatment are potential risk factors for
occlusal relapse.occlusal relapse.

If the treatment is performed in the mixedIf the treatment is performed in the mixed
dentition periods retention thus will bedentition periods retention thus will be
necessary, until all the permanent teethnecessary, until all the permanent teeth
have erupted & occlusion is stabilized.have erupted & occlusion is stabilized.
The Andersens activator is most suitableThe Andersens activator is most suitable
retention device after Herbst therapy.retention device after Herbst therapy.
Selective trimming of the acrylic makesSelective trimming of the acrylic makes
interocclusal adjustments possible byinterocclusal adjustments possible by
guiding tooth eruption.guiding tooth eruption.

As the treatment with Herbst appliance isAs the treatment with Herbst appliance is
performed during a relatively short period,performed during a relatively short period,
the hard & soft tissues will need some timethe hard & soft tissues will need some time
for adaptation to the new mandibularfor adaptation to the new mandibular
position.position.
Minor relapse of overjet & overbite is aMinor relapse of overjet & overbite is a
common finding, so it is advised to finish thecommon finding, so it is advised to finish the
Herbst therapy case with mild reverseHerbst therapy case with mild reverse
overjet & a super class I molar relationship.overjet & a super class I molar relationship.

JASPER JUMPERJASPER JUMPER

Jasper jumper -Jasper jumper -
developed & patented by James.j jasper indeveloped & patented by James.j jasper in
1987.1987.
The term jasper jumper is a contrivanceThe term jasper jumper is a contrivance
combining the surname of its inventor withcombining the surname of its inventor with
the functional concept expounded bythe functional concept expounded by
Kingsley in late 19Kingsley in late 19thth
century (jumping thecentury (jumping the
bite).bite).

Jasper jumper is a relatively new tooth borneJasper jumper is a relatively new tooth borne
appliance capable of producing rapidappliance capable of producing rapid
change in occlusal & intermaxillarychange in occlusal & intermaxillary
relationship.relationship.
It is aIt is a flexible fixed applianceflexible fixed appliance that delivers lightthat delivers light
,continuous forces that can move the teeth,continuous forces that can move the teeth
slightly , in a large group or an entire arch toslightly , in a large group or an entire arch to
produce significant dento alveolar & profileproduce significant dento alveolar & profile
changes.changes.

The Jasper Jumper has 3 particular features –The Jasper Jumper has 3 particular features –
It leaves standard oral functions such asIt leaves standard oral functions such as
mastication & phonetics unimpaired bymastication & phonetics unimpaired by
virtue of its slenderness & flexibility.virtue of its slenderness & flexibility.
It maintains the sence of touch of opposingIt maintains the sence of touch of opposing
tooth.tooth.
It cannot be removed readily from theIt cannot be removed readily from the
mouth.mouth.

Design & construction featuresDesign & construction features
The Jasper jumper is anThe Jasper jumper is an
open coil, embeddedopen coil, embedded
in soft synthetic & isin soft synthetic & is
attached throughattached through
special connectingspecial connecting
pieces.pieces.

Without plastic jacket it isWithout plastic jacket it is
3 material workpiece,3 material workpiece,
comprising connectorcomprising connector
– open coil –– open coil –
connector.connector.
With the link betweenWith the link between
the coil spring & thethe coil spring & the
eyelets being made byeyelets being made by
soldering.soldering.

Other accessoriesOther accessories
supplied are –supplied are –
A ball stopA ball stop – placed on a– placed on a
continuous orcontinuous or
segmented orthodonticsegmented orthodontic
archwire, forming aarchwire, forming a
ventral stop for theventral stop for the
appliance.appliance.

A ball pinA ball pin – with which– with which
the appliance isthe appliance is
attached to the upperattached to the upper
head gear tube.head gear tube.

Clinical managementClinical management..
Preparation of the arches.Preparation of the arches.
Preparation of the anchorage.Preparation of the anchorage.
Selection & installation of the appliance.Selection & installation of the appliance.
Activation of the module.Activation of the module.
Reactivation of the module.Reactivation of the module.

Anchorage preparation-Anchorage preparation-
This is most important aspect of clinicalThis is most important aspect of clinical
management.management.
The action of the Jasper tends to expandThe action of the Jasper tends to expand
the upper molars, so slight amount ofthe upper molars, so slight amount of
constriction in the posterior segment of theconstriction in the posterior segment of the
archwire is recommended.archwire is recommended.
A transpalatal arch should be used for a 3A transpalatal arch should be used for a 3
dimensional control of the molars.dimensional control of the molars.

Use of a fixed lower lingual arch is stronglyUse of a fixed lower lingual arch is strongly
encouraged in most of the cases.encouraged in most of the cases.
In the lower archIn the lower arch lingual crown torquelingual crown torque isis
incorporated in the anterior segment toincorporated in the anterior segment to
counteract the labial displacement ( tipping)counteract the labial displacement ( tipping)
effect on the lower anteriors.effect on the lower anteriors.

Prepration of the arches –Prepration of the arches –
Arches are prepared by aligning the upper &Arches are prepared by aligning the upper &
lower teeth with fixed mechanotherapy.lower teeth with fixed mechanotherapy.
After the alignment is complete in bothAfter the alignment is complete in both
upper & lower arches, lower 1upper & lower arches, lower 1stst
& 2& 2ndnd
premolars brackets are removed bilaterally.premolars brackets are removed bilaterally.
Second molars should be included in the setSecond molars should be included in the set
up if possible.up if possible.

Selection & Installation of appliance -Selection & Installation of appliance -
Lower rectangular archwire is fabricatedLower rectangular archwire is fabricated
with anterior bends & bayonet bends distalwith anterior bends & bayonet bends distal
to the cuspids. Ball is slided on to theto the cuspids. Ball is slided on to the
archwire.archwire.
To get the right length , patient is asked to biteTo get the right length , patient is asked to bite
in their retruded / centric position.in their retruded / centric position.

From the mesial of the headgear tube to theFrom the mesial of the headgear tube to the
distal of lower ball stop, is measured & 12distal of lower ball stop, is measured & 12
mm is added to it –mm is added to it –
4mm for the tube.4mm for the tube.
4mm for the free play.4mm for the free play.
4mm for the built in activation.4mm for the built in activation.

 After selection of the proper size, right & leftAfter selection of the proper size, right & left
jaspers are slided on to the lower archwire &jaspers are slided on to the lower archwire &
ligated.ligated.
 Distal end of the archwire is cinched back toDistal end of the archwire is cinched back to
prevent the anterior movement.prevent the anterior movement.
 After fixing the lower arch, upper ball pin is passedAfter fixing the lower arch, upper ball pin is passed
through the distal of the jumper & then through thethrough the distal of the jumper & then through the
head gear tube from the distal end.The ball pin ishead gear tube from the distal end.The ball pin is
bent in to hook to secure it, at least 2mm of spacebent in to hook to secure it, at least 2mm of space
should be left between the upper ball pin & distalshould be left between the upper ball pin & distal
of tube for free play.of tube for free play.

Activation –Activation –
The jasper modules initially are selected &The jasper modules initially are selected &
placed so that the module assumes a mildlyplaced so that the module assumes a mildly
curved contour when the patient is holdingcurved contour when the patient is holding
the jaw in a comfortably retruded position.the jaw in a comfortably retruded position.
In a growing individual in whom the orthopedicIn a growing individual in whom the orthopedic
repositioning of the mandible is desired,repositioning of the mandible is desired,
higher force levels ( 6-8 ounces ) are usedhigher force levels ( 6-8 ounces ) are used
continuously.continuously.

Reactivation of the module –Reactivation of the module –
If the class II molar relation is not correctedIf the class II molar relation is not corrected
completely by the initial activation of thecompletely by the initial activation of the
appliance ,it should be reactivated 2-3appliance ,it should be reactivated 2-3
months after initial placement.months after initial placement.
The appliance is activated by shortening theThe appliance is activated by shortening the
attachment to the maxillary 1attachment to the maxillary 1stst
molar bands.molar bands.

The pin extending through the headgearThe pin extending through the headgear
tube is pulled anteriorly 1-2 mm on eachtube is pulled anteriorly 1-2 mm on each
side.side.
Use of the crimpable stops of 1 or 2mmUse of the crimpable stops of 1 or 2mm
placed mesial to the ball can produce aplaced mesial to the ball can produce a
controlled activation of the modules.controlled activation of the modules.

Treatment effectsTreatment effects
When the Jasper jumper is first installed , itWhen the Jasper jumper is first installed , it
bows toward the cheek & the mandiblebows toward the cheek & the mandible
moves forward to a neutral position .moves forward to a neutral position .
Mastication then helps to deliver theMastication then helps to deliver the
intrusive & distalizing force on the upperintrusive & distalizing force on the upper
molars , much as a high pull headgear ,molars , much as a high pull headgear ,
along with intrusive force that work to levelalong with intrusive force that work to level
the lower anterior teeth.the lower anterior teeth.

Intrusion & distalization of the upper molarsIntrusion & distalization of the upper molars
with occasional opening of the posteriorwith occasional opening of the posterior
bite.bite.
Some indications of condylar growth.Some indications of condylar growth.
Anterior migration of the anterior teethAnterior migration of the anterior teeth
through alveolar bone.through alveolar bone.
Intrusion of the lower incisors.Intrusion of the lower incisors.
Expansion of upper molars ifExpansion of upper molars if precautionprecaution isis
not taken.not taken.

The hypothesized mechanism of class II correctionThe hypothesized mechanism of class II correction
with jasper jumper includes –with jasper jumper includes –
 Basal restraint of maxilla.Basal restraint of maxilla.
 Dentoalveolar retraction of the maxillary dentition.Dentoalveolar retraction of the maxillary dentition.
 Increased growth of the mandibular condyle.Increased growth of the mandibular condyle.
 Downward / forward glenoid fossa remodelling.Downward / forward glenoid fossa remodelling.
 Lateral expansion of the maxillary molars.Lateral expansion of the maxillary molars.

According to study done by Blackwood &According to study done by Blackwood &
Buschange et. al., results revealed thatBuschange et. al., results revealed that
primary effect wasprimary effect was dental rather thandental rather than
skeletal effects.skeletal effects.
Class II correction was achieved primarily byClass II correction was achieved primarily by
dento alveolar movements & secondarily bydento alveolar movements & secondarily by
basal maxillary restraint.basal maxillary restraint.

They concluded-They concluded-
The maxilla underwent limited posteriorThe maxilla underwent limited posterior
displacement & continued its normal inferiordisplacement & continued its normal inferior
descent.descent.
Mandible showed little or no growthMandible showed little or no growth
stimulation.stimulation.
Maxillary molars underwent significantMaxillary molars underwent significant
posterior tipping & relative intrusion.posterior tipping & relative intrusion.

The maxillary incisors underwent significantThe maxillary incisors underwent significant
posterior tipping & extrusion.posterior tipping & extrusion.
The mandibular incisors underwentThe mandibular incisors underwent
significant uncontrolled forward tipping &significant uncontrolled forward tipping &
intrusion.intrusion.

Jasper’s “theory of two” suggested that class IIJasper’s “theory of two” suggested that class II
correction with jasper jumper can be equallycorrection with jasper jumper can be equally
partitioned between 5 components –partitioned between 5 components –
 20% due to maxillary basal restraint.20% due to maxillary basal restraint.
 20% due to backward maxillary dentoalveolar20% due to backward maxillary dentoalveolar
movement.movement.
 20% due to forward mandibular dento alveolar20% due to forward mandibular dento alveolar
movement.movement.
 20% due to condylar growth stimulation.20% due to condylar growth stimulation.
 20% due to forward / downward glenoid fossa20% due to forward / downward glenoid fossa
remodelling.remodelling.

Indications –Indications –
Dental class II malocclusion.Dental class II malocclusion.
Skeletal class II with maxillary excess asSkeletal class II with maxillary excess as
opposed to mandibular deficiency.opposed to mandibular deficiency.
Deep bite with retroclined mandibularDeep bite with retroclined mandibular
incisors.incisors.

Contraindications –Contraindications –
Cases predisposed to root resorption.Cases predisposed to root resorption.
Dental & skeletal open bites.Dental & skeletal open bites.
Vertical growth pattern.Vertical growth pattern.
High mandibular plane angle & increasedHigh mandibular plane angle & increased
lower anterior face height.lower anterior face height.

Additional applicationsAdditional applications
Maxillary adaptationsMaxillary adaptations
1.1. Headgear effect –Headgear effect –
One of the most easily produced effect by any suchOne of the most easily produced effect by any such
appliance is distalization effect on the upperappliance is distalization effect on the upper
molar, also called as headgear effect.molar, also called as headgear effect.
In growing individuals as well as adults, ifIn growing individuals as well as adults, if
distalization is desired, the wire should not bedistalization is desired, the wire should not be
cinched back. (Cash 1991)cinched back. (Cash 1991)
If distalization is not required the wire should beIf distalization is not required the wire should be
cinched back properly.cinched back properly.

2.2. Retraction of anterior teeth –Retraction of anterior teeth –
canines can be retracted in both extraction &canines can be retracted in both extraction &
non extraction cases with the posteriornon extraction cases with the posterior
maxillary dentition supported by jasper, &maxillary dentition supported by jasper, &
a NiTi coil spring or an intermaxillarya NiTi coil spring or an intermaxillary
elastic attached to the pin through the faceelastic attached to the pin through the face
bow tube.bow tube.

3.3. Dental asymmetriesDental asymmetries ––
Jasper can also be used in patients who haveJasper can also be used in patients who have
sagittal dental asymmetries. In a patientsagittal dental asymmetries. In a patient
with a class II subdivision type ofwith a class II subdivision type of
malocclusion the maxillary arch wire can bemalocclusion the maxillary arch wire can be
tied back on the side of existing class Itied back on the side of existing class I
molar relationship. Asymmetric orthopedicmolar relationship. Asymmetric orthopedic
effects may be achieved.effects may be achieved.

Mandibular adaptationsMandibular adaptations
 In growing individuals changes in the mandibularIn growing individuals changes in the mandibular
position are achieved after force application.position are achieved after force application.
 In an attempt to produce mandibular advancementIn an attempt to produce mandibular advancement
,the movement of the maxillary posterior dentition,the movement of the maxillary posterior dentition
must be minimized to maximize the mandibularmust be minimized to maximize the mandibular
change.change.
 It can be used in cases of class III malocclusion.It can be used in cases of class III malocclusion.

Trouble shooters in Jasper jumperTrouble shooters in Jasper jumper
therapytherapy
BreakageBreakage : jasper is not a very fragile: jasper is not a very fragile
appliance, but patient is advised not toappliance, but patient is advised not to
resist the push of the appliance. patientresist the push of the appliance. patient
should be advised to avoid excessive lateralshould be advised to avoid excessive lateral
torquing of the appliance.torquing of the appliance.
Flaring of the lower incisorsFlaring of the lower incisors : in a well: in a well
maintained case where arches are preparedmaintained case where arches are prepared
adequately , lower incisor flaring will beadequately , lower incisor flaring will be
minimal.minimal.

Tipping & buccal flaring of the upper 1Tipping & buccal flaring of the upper 1stst
molarsmolars
: can be minimized by giving constriction in: can be minimized by giving constriction in
the arch wire & using TPA.the arch wire & using TPA.

Mandibular protractionMandibular protraction
applianceappliance

Correctly relating the maxilla and the mandible hasCorrectly relating the maxilla and the mandible has
always been a primary concern of orthodontists inalways been a primary concern of orthodontists in
treating class II malocclusions .Device proposedtreating class II malocclusions .Device proposed
for such treatment have ranged from intermaxillaryfor such treatment have ranged from intermaxillary
elastics to head gear to removable functionalelastics to head gear to removable functional
appliances.appliances.
More recent appliances as Herbst & Jasper jumper,More recent appliances as Herbst & Jasper jumper,
have advantage of being rigidly fixed & lesshave advantage of being rigidly fixed & less
dependent on patient co operationdependent on patient co operation

The author has developed new appliance thatThe author has developed new appliance that
reposition the mandible forward.reposition the mandible forward.
This appliance is proven effective in treatingThis appliance is proven effective in treating
class I patients with exaggerated overjets &class I patients with exaggerated overjets &
class II subdivision patients.class II subdivision patients.

Ease of fabrication.Ease of fabrication.
Low cost.Low cost.
Infrequent breakage.Infrequent breakage.
Patient comfort.Patient comfort.
Rapid installation.Rapid installation.

The first type of mandibular protractionThe first type of mandibular protraction
appliance (MPA) requires stainless steelappliance (MPA) requires stainless steel
edgewise archwires in both arches.edgewise archwires in both arches.
The mandibular archwire requiresThe mandibular archwire requires stopsstops suchsuch
asas circles, crimpable hooks, or loopscircles, crimpable hooks, or loops distaldistal
to the cuspids to prevent direct contactto the cuspids to prevent direct contact
between the appliance and the bondedbetween the appliance and the bonded
brackets.brackets.

The lower archwire should have enoughThe lower archwire should have enough
lingual torque in the anterior region to resistlingual torque in the anterior region to resist
labial displacement of the lower incisorslabial displacement of the lower incisors
from the protrusive pressure of thefrom the protrusive pressure of the
appliance. It should be tightly cinched backappliance. It should be tightly cinched back
with a tip-down distal to the mandibularwith a tip-down distal to the mandibular
tube.tube.

Each side of the appliance is made byEach side of the appliance is made by
bending a small loop at a right angle to thebending a small loop at a right angle to the
end of an .032" stainless steel wire .end of an .032" stainless steel wire .
The length of the appliance is thenThe length of the appliance is then
determined by protruding the mandible intodetermined by protruding the mandible into
a position with proper overjet, overbite, anda position with proper overjet, overbite, and
midline correction and measuring themidline correction and measuring the
distance from the mesial of the maxillarydistance from the mesial of the maxillary
tube to the stop on the mandibular archwire.tube to the stop on the mandibular archwire.

 Another small right-angle circle is then bent in anAnother small right-angle circle is then bent in an
opposite direction into the other end of the .032"opposite direction into the other end of the .032"
stainless steel wire.stainless steel wire.
 The angulation of these circle bends can vary toThe angulation of these circle bends can vary to
allow free sliding along the mandibular archwire.allow free sliding along the mandibular archwire.
One appliance circle is placed over the maxillaryOne appliance circle is placed over the maxillary
archwire against the molar tube, and the otherarchwire against the molar tube, and the other
circle against the mandibular archwire stop. Bothcircle against the mandibular archwire stop. Both
circles are then closed completely with a plier.circles are then closed completely with a plier.

However, to allowHowever, to allow
sufficient clearance forsufficient clearance for
sliding along thesliding along the
mandibular wire,mandibular wire,
bicuspid brackets mustbicuspid brackets must
be omitted, and abe omitted, and a
buccal offset in thebuccal offset in the
lower archwire is oftenlower archwire is often
needed.needed.

 The radical improvement he accounts notThe radical improvement he accounts not
only for the mandibular growth , butonly for the mandibular growth , but
dentoalveolar changes imposed bydentoalveolar changes imposed by
appliances constant pressure.appliances constant pressure.
 With careful patient selection & judiciousWith careful patient selection & judicious
use , this appliance works quite effectively.use , this appliance works quite effectively.

But impossibility of bonding the lowerBut impossibility of bonding the lower
bicuspids combined with appliances limitedbicuspids combined with appliances limited
mouth opening & frequent dislodgement ofmouth opening & frequent dislodgement of
molar bands made the author to developmolar bands made the author to develop
second protrusion appliance.second protrusion appliance.

MPA.2MPA.2

 The MPA No. 2 is fabricated by makingThe MPA No. 2 is fabricated by making
right-angle circles in two pieces of .032’’right-angle circles in two pieces of .032’’
stainless steel wire. A small piece of rigidstainless steel wire. A small piece of rigid
coil or stainless steel tubing is slipped overcoil or stainless steel tubing is slipped over
one of the wires.one of the wires.
 Coil can be made from.024’’s.s wire.Coil can be made from.024’’s.s wire.

One end of each wire is inserted through theOne end of each wire is inserted through the
other wire's loop , so that each wire passesother wire's loop , so that each wire passes
through the other up to the limit of the wirethrough the other up to the limit of the wire
coil . The coil prevents the two wires fromcoil . The coil prevents the two wires from
interfering with each other and ensures theirinterfering with each other and ensures their
correct relationship.correct relationship.

The maxillary edgewise archwire is madeThe maxillary edgewise archwire is made
with an ordinary amount of anterior torquewith an ordinary amount of anterior torque
and with occlusally directed circles againstand with occlusally directed circles against
the molar tubes.the molar tubes.
The mandibular edgewise archwire shouldThe mandibular edgewise archwire should
have sufficient torque in the anterior portionhave sufficient torque in the anterior portion
to resist labial incisor inclination and shouldto resist labial incisor inclination and should
have occlusally directed circles placedhave occlusally directed circles placed
about 2-3mm distal to each cuspid.about 2-3mm distal to each cuspid.

The lower arch wires should be firmlyThe lower arch wires should be firmly
cinched back by bending archwire downcinched back by bending archwire down
distal to the molar tubes.distal to the molar tubes.
Both MPA 1 & MPA 2 permanentlyBoth MPA 1 & MPA 2 permanently
reposition the mandible forward & rely on areposition the mandible forward & rely on a
combination of condylar growth &combination of condylar growth &
dentoalveolar adaptation to achieve a classdentoalveolar adaptation to achieve a class
I posterior occlusion.I posterior occlusion.

 Ease of fabrication.Ease of fabrication.
 Low cost.Low cost.
 No special bands ,crowns or wire attachments.No special bands ,crowns or wire attachments.
 No impressions or wax bite no lab. assistance.No impressions or wax bite no lab. assistance.
 Infrequent breakage.Infrequent breakage.
 They permit greater range of motion & are lessThey permit greater range of motion & are less
restrictive of movements compared to otherrestrictive of movements compared to other
appliances.appliances.
 Patient comfort.Patient comfort.
 Rapid installation.Rapid installation.

MPA 3MPA 3

 The Mandibular Protraction Appliances haveThe Mandibular Protraction Appliances have
proven reliable and efficient in the correction ofproven reliable and efficient in the correction of
various aspects of Class II malocclusions,various aspects of Class II malocclusions,
including overjet, overbite, midline shift, spacing,including overjet, overbite, midline shift, spacing,
and molar position.and molar position.
 Unfortunately, problems of breakage, restrictedUnfortunately, problems of breakage, restricted
opening, and patient discomfort associated withopening, and patient discomfort associated with
the MPA No. 1 and the difficulty of chair sidethe MPA No. 1 and the difficulty of chair side
construction of the MPA No. 2 have discouragedconstruction of the MPA No. 2 have discouraged
many orthodontists from using these appliances.many orthodontists from using these appliances.

Appliance constructionAppliance construction
The parts needed for the construction of the MPAThe parts needed for the construction of the MPA
No. 3 are:No. 3 are:
•• Two maxillary tubes of .045" internal diameter,Two maxillary tubes of .045" internal diameter,
each about 27mm long.each about 27mm long.
•• Two maxillary loops of .040" stainless steel wire,Two maxillary loops of .040" stainless steel wire,
each about 13mm long, with a loop bent into oneeach about 13mm long, with a loop bent into one
end at an angle of about 130° to the horizontal.end at an angle of about 130° to the horizontal.
•• Two mandibular rods of .036" stainless steel wire,Two mandibular rods of .036" stainless steel wire,
each about 27mm long.each about 27mm long.

•• Four pieces of band material.Four pieces of band material.
•• Two short lengths of annealed .036"Two short lengths of annealed .036"
stainless steel wire, each with a loop in onestainless steel wire, each with a loop in one
end, for attaching the appliance to theend, for attaching the appliance to the
maxillary molar headgear tube.maxillary molar headgear tube.

Prepare a stainless steel edgewisePrepare a stainless steel edgewise
mandibular archwire by bending an “O” loopmandibular archwire by bending an “O” loop
on each side distal to the cuspid, windingon each side distal to the cuspid, winding
the wire twice around a Tweed loop-formingthe wire twice around a Tweed loop-forming
plier.plier.
 preferably a .019’’x .02’’ wire, but smallerpreferably a .019’’x .02’’ wire, but smaller
and more flexible wires such as .016’’x .and more flexible wires such as .016’’x .
022’’ and .017’’x .025’’ have reportedly022’’ and .017’’x .025’’ have reportedly
resisted breakage with the MPA No. 3resisted breakage with the MPA No. 3

Prepare each .036’’ mandibular rod byPrepare each .036’’ mandibular rod by
making a 90° bend at one end . Place amaking a 90° bend at one end . Place a
small piece of tubing over the same end,small piece of tubing over the same end,
then crimp and weld it so it stays fixed.then crimp and weld it so it stays fixed.
 Insert the longer leg of the mandibular rodInsert the longer leg of the mandibular rod
through the “O” loop in the archwire fromthrough the “O” loop in the archwire from
the lingual. Manipulate the rod upward untilthe lingual. Manipulate the rod upward until
it is nearly perpendicular to the wire.it is nearly perpendicular to the wire.

Place the mandibular archwire in the mouthPlace the mandibular archwire in the mouth
so that enough wire extends distal to theso that enough wire extends distal to the
molar tube for a bend-down tieback.molar tube for a bend-down tieback.
 Whenever possible, include the secondWhenever possible, include the second
molars to increase anchorage.molars to increase anchorage.
The maxillary arch can be fully or partiallyThe maxillary arch can be fully or partially
bonded, using any type and size of archwirebonded, using any type and size of archwire
—round or edgewise.—round or edgewise.

 This wire can be tied back or not, depending onThis wire can be tied back or not, depending on
whether en masse movement of the maxillarywhether en masse movement of the maxillary
teeth or merely distal molar movement is desired.teeth or merely distal molar movement is desired.
 Attach the maxillary tube to the distal end of theAttach the maxillary tube to the distal end of the
maxillary first molar headgear tube by threadingmaxillary first molar headgear tube by threading
the short, annealed stainless steel pin through thethe short, annealed stainless steel pin through the
loop of the MPA tube and then through theloop of the MPA tube and then through the
headgear tube. Bend the annealed pin downheadgear tube. Bend the annealed pin down
mesial to the headgear tube.mesial to the headgear tube.

Ask the patient to position the mandible toAsk the patient to position the mandible to
correct any overbite, overjet, and midlinecorrect any overbite, overjet, and midline
deviation, then use the assembled maxillarydeviation, then use the assembled maxillary
tube to measure the distance from the distaltube to measure the distance from the distal
end of the headgear tube to the “O” loop onend of the headgear tube to the “O” loop on
the mandibular archwire.the mandibular archwire.
 Mark and cut the tube at this point.Mark and cut the tube at this point.

 The MPA No. 3 allows almost unrestrictedThe MPA No. 3 allows almost unrestricted
opening, to at least 50-55mm.opening, to at least 50-55mm.
 As with the other MPAs, it can be usedAs with the other MPAs, it can be used
unilaterally; patients generally find thisunilaterally; patients generally find this
version more comfortable than the bilateralversion more comfortable than the bilateral
variety.variety.

AdvantagesAdvantages
It is more comfortable for the patient, and thusIt is more comfortable for the patient, and thus
promotes better compliance.promotes better compliance.
•• It offers greater range of motion.It offers greater range of motion.
•• It is equally simple and inexpensive, butIt is equally simple and inexpensive, but
easier to place.easier to place.
•• It is adaptable to either Class II or Class IIIIt is adaptable to either Class II or Class III
cases.cases.

•• It can be used for mandibular positioning orIt can be used for mandibular positioning or
dentoalveolar movement.dentoalveolar movement.
•• It causes less breakage of archwires andIt causes less breakage of archwires and
appliances and thus fewer emergencyappliances and thus fewer emergency
appointments.appointments.

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.and Steve Prins.
The fore runner to eureka spring was aThe fore runner to eureka spring was a
system devised by North cutt in 1974.system devised by North cutt in 1974.
 It is a three part telescopic appliance fixedIt is a three part telescopic appliance fixed
to the upper arch at the level of the molarto the upper arch at the level of the molar
band and to the lower arch distal to theband and to the lower arch distal to the
cuspid.cuspid.

Fixed Functional Appliances Guide

Fixed Functional Appliances Guide

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