Fixed functional appliances1 / /certified fixed orthodontic courses by Indian dental academy

FIXED FUNCTIONAL APPLIANCES

INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com


Contents
Classification
Herbst appliance
Type 1, II, IV
Modifications of Herbst appliance
Cast splint herbst, Herbst with stainless steel
crown, The bonded Herbst appliance, The
Acrylic splint Herbst appliance , Headgear –
Herbst appliance, Cantileverd Herbst appliance,
Modified Herbst appliance for the mixed
dentition, The EMDEN Herbst, Edgewise Herbst
Appliance, Mandibular Advancement Locking
Unit (MALU), Flip-Lock Herbst Appliance
Jasper Jumper
MARS Appliance

Mandibular Protraction appliances :
MPA 1,MPA 2, MPA 3 ,
MPA4
Adjustable Bite corrector (ABC)
The Eureka Spring
The churro jumper
The universal bite jumper
The saif Spring
Ritto Appliance
The Magnetic Telescopic Device

THE TWIN FORCE BITE CORRECTOR
ALPERN CLASS II CLOSERS
Mandibular Corrector
The Horizontal Anterior Positioning (HAP)
appliance
The Mandibular Anterior Repositioning
Appliance(MARA)
Functional Mandibular Advancer
The Biopedic appliance
The Klapper Superspring II appliance
Forsus Fatigue resistant Device

Classification
According to the forces produced:
Appliances producing pushing forces
Appliances producing pulling forces


Appliances producing
Pushing forces:
 These

appliances
deliver a pushing
force vector
forcing the
attachment points
of the appliance
away from one
another


Rigid:
 1.

Herbst Appliance and its modifications.
 2. Mandibular advancement repositioning
splint
 3. Mandibular protraction appliance
 4. Eureka Spring
 5. Universal Bite Jumper
 6. Biopedic
 7. Mandibular anterior repositioning
appliance
 8.


Flexible:
 Jasper

Jumper
 Churro Jumper
 Adjustable Bite Corrector
 Universal Bite Jumper
 Klapper Super Spring II
 Forsus


Appliances Producing Pulling
Force
These appliances create a
pulling force vector
between the points of
attachment:
 SAIF (Severable
Adjustable intermaxillary
Force) spring


Herbst Appliance
History, Background and Development
Design
Anchorage forms of the Herbst Appliance
Construction
Effects on Dentofacial Complex
Effects on facial profile
Effects on masticatory system
Mandibular anchorage problems
Indications
Timing
Retention

History, Background
and Development
Developed by Emil Herbst (1872 – 1940) in
1900s.He lived in Bremen, Germany.
He called his appliance
“Okklusionsscharnier” or “Retentionsscharnier”
(Sharnier = Joint and Retention was added since
the upper part of the appliance served as a
retainer for an expanded maxillary dental arch.)

Herbst presented his appliance (original
banded design) for the first time at the 5th
international Dental Congress in Berlin in
1909.
In 1934 Martin Schwarz from Vienna criticized
that the Herbst appliance could result in an
overload of the anchorage teeth with
periodontal damage as a consequence.
This claim was recently disapproved by Pietz
in his Thesis(2000)

However after 1934, very little was published
about the Herbst appliance, and the treatment
method was more or less forgotten until it was
rediscovered by Pancherz in the late 1970s.


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

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

Each telescope consists of a tube, a plunger,
2 pivots (axle), and two locking screws that
prevent the telescoping parts from slipping past
the pivots.


Length of the plunger should be kept
at a maximum to prevent it from
disengaging from the tube.
A large interpivot distance prevents
the plunger from slipping out of the
tube when the mouth is opened
wide.
A plunger too far behind the tube can
injure the buccal mucosa.
If plunger disengages from the tube
on mouth opening , it may get stuck
in the tube opening on subsequent
mouth closure and damage the
appliance.

Original Herbst
Appliance
Originally Herbst had the
telescope mechanism
placed upside down (with
plunger attached to the
maxillary molar crown and
the tube on the mandibular
canine crown).
Tube had no open end ,
thus not allowing the
plunger to extend behind
the tube.


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


Anchorage forms of the
Herbst appliance
Deserves special attention.
Because of anchorage loss, maxillary and
mandibular tooth movements cannot be
avoided.
Several anchorage systems have been
developed to control unwanted tooth
movements.

Anchorage forms used from

1909 to 1934:

The standard anchorage
system used by Herbst:
Crowns or caps were
placed on the maxillary
permanent first molars and
mandibular first premolars
(sometimes canines).
The crowns/caps were joined
by wires that run along the
palatal surfaces of the upper
teeth and the lingual surfaces
of the lower teeth.

If second permanent molars
have not erupted then Herbst
advised to anchor the
appliance more firmly by
placing bands on the canines,
which were soldered to the
palatal arch wire as were the
upper molars.
Alternative to bands on the
upper canines, a thin gold wire
was placed on the labial
surfaces of the upper incisors
and soldered to the palatal arch
wire.

Early mixed dentition
anchorage system:
When using the Herbst
appliance in the early mixed
dentition, Herbst had the
following solution:
In the maxilla, the permanent
central incisors were used for
anchorage instead of the
cuspids.
In the mandible, crowns were
placed on the first permanent
molars and bands on the 4
permanent incisors.

Late mixed dentition anchorage
system
Canines are used as
anchorage teeth instead of
incisors.
Buccal mucosa at the
corner of the mouth is
prone to ulceration when
mandibular canine is used
as an abutment tooth for
the plunger.

Herbst and others realized the
necessity of incorporating as many
teeth as possible for anchorage to
avoid unwanted side effects.
Schwarz( 1934): Most teeth in the
maxilla and mandible were
interconnected by labial as well as
lingual arch wires( Block anchorage)


Anchorage forms used from 1979
onward:
Pancherz originally used a banded type of Herbst
appliance.Individually made stainless steel bands of a
thick material (0.15- 0.18mm) were used.
Simple anchorage system
2. Increased anchorage system
3. Total anchorage system
4. Cantilever Herbst
1.


Simple anchorage system
Maxilla- Bands are
placed on 1st permanent
molars and first
premolars. Joined on
each side by sectional
arch wires.
Mandible- Premolars
are banded and
connected with a lingual
sectional arch.






Disadvantages:
Space opening distal to maxillary canines
Excessive intrusion of 1st permanent molars.
Buccal tipping of 1st premolars
Large proclination of lower anteriors

• Thus, anchorage had to be increased

by incorporating more teeth.


2. Increased anchorage
system
 Maxillary and mandibular

front teeth were
incorporated in the
anchorage system by labial
sectional arch wires.
 Mandibular lingual arch wire

extended to 1st permanent
molars.


Since 1995, cast chromecobalt splints are used
routinely.
The splints cover all buccal
teeth in the maxillary and
mandibular arches and also
the mandibular canines.
Chair time is short and the
appliance is strong, hygienic,
and causes few clinical
problems.


In the early 1980s, Howe and
McNamara developed the
acrylic splint Herbst appliance
which is used both.as a fixed
(bonded to the teeth) and
removable appliance.
However, use of the Herbst
as a removable device is not
recommended because the
main advantage of a fixed
Herbst appliance is that it
works 24 hours a day without
the dependence on patient
cooperation.

The so-called cantilever Herbst
appliance design is mainly
indicated in the early mixed
dentition before the eruption of
the mandibular permanent
canines and first premolars.
The lower part has heavy metal
extension arms that are soldered
to the permanent first molar
crowns.
The arms extend anteriorly,
lateral to the dentition and
terminates in the premolar region
in which the telescoping axles

Support wires attached to the cantilever arms,
working as occlusal rests on the first or second
deciduous molars are important.
Without these rests (as seen in earlier designs of
this appliance), the vertical force vector of the
telescopes acting as lever arms will result in
uncontrolled mesial tipping and extrusion
(extraction) of the molar teeth.
But the anchorage control of the mandibular
molars with the cantilevers (even when using
occlusal rests on the deciduous molars) is
questionable.

None of the anchorage systems used in
Herbst treatment could prevent anterior
movement of the mandibular incisors and
molars. ( Pancherz and Hansen1988)
Lower anchorage is a problem difficult to
master in Herbst treatment. Some factors
associated with anchor loss can be :



Severity of A-P interarch discrepancy
Amount of bite jumping at the start of
treatment.


TRETMENT EFFECTS

SAGITTAL



VERTICAL

DENTAL
SKELETAL

DENTAL
SKELETAL


SAGITTAL CHANGES

I. Skeletal:
 1.Restrains

maxillary growth and decrease
of SNA angle.

 2.

Increases mandibular length
(Pancherz 1979, 1981, 1982). This finding
is in agreement with several bite jumping
experiments in growing monkeys (Stockle
and Willert 1971, McNamara 1972, 1973,
1975) and rats (Petrovic and Stutzman
1969).

2a. Evidence of temporomandibular
growth adaptations in Herbst treatment:
Three adaptive processes in the TMJ are
thought to contribute to the changes of
mandibular position.
1)

Condylar remodeling.
(2)Glenoid fossa remodeling;
(3) Condylar position changes within the
fossa.


Animal studies
Peterson and McNamara (semin
orthodontics 2003) :
Evaluated histologically the TMJ, glenoid
fossa, and the posterior border of the
mandible in juvenile Rhesus monkeys
whose mandibles had been positioned
forward with a Herbst appliance.

The following adaptations were observed:Condyle remodelling :
 Increased proliferation of condylar cartilage was
noted. It occurred primarily in the posterior and
posterosuperior regions of the condyle.
Glenoid fossa remodelling :
 Significant deposition of new bone on the
anterior surface of the postglenoid spine
occurred, indicating an anterior repositioning of
the glenoid fossa. Similar to (Breitner 1930,33).
 Significant

bone resorption on the posterior
surface of the postglenoid spine was noted.

Significant bony apposition on the
posterior border of the mandibular ramus
was evident during early experimental
periods.
No gross or microscopic pathological
changes were noted in TMJ of the
juvenile Rhesus monkey.


CLINICAL STUDIES:
Have provided radiographic evidence of
TMJ growth adaptation in Herbst
treatment.


Paulsen et al (1995) :
Analysed TMJ changes in a single case of
Herbst treatment in late puberty using CT
scanning and OPG.
Three months after insertion of the appliance
CT-scanning and OPGs of the TMJ revealed
new bone formation as a double contour in
the articular fossa and on the posterior part of
the condylar process as a result of adaptive
bone remodeling.


Roentgenograms of the
mandibular joints (N =
33). A, Before treatment.
B, After active treatment.
C, After the retention
period. A double contour
of the fossa outline was
found on
roentgenograms. The
double contour
disappeared in all cases
during the retention
period.

Ruf and Pancherz (1998, 1999):
Analysed three possible adaptive TMJ growth
processes contributing to increase in mandibular
prognathism accomplished by Herbst treatment :
Condylar remodeling
Glenoid fossa remodeling
Condyle fossa relationship changes.
Aidar, Abrahao ,Yamashita , Dominguez (AJO
2006) assesed the TMJ disc position with MRI
after 12 month period of herbst appliance therapy
in 20 ClassII div1 patients. They found mild
changes in position of the disc with slight
tendency towards retrusion due to mandibular
advancement which returned to normal after
appliance removal. These changes were in the
normal phsiological limits as evaluated in short
term.

II. Dental:
Dental changes seen during Herbst appliance
treatment are basically a result of anchorage
loss in the two dental arches. The telescope
mechanism produces a posterior directed
force on the upper teeth and an anterior
directed force on the lower teeth, resulting in
distal tooth movements in the maxillary
buccal segments and mesial tooth
movements in the mandible.


1. Mandibular teeth are moved
anteriorly
Proclination of lower anteriors. Mandibular
incisors proclined on an average of 6.6°
during 6 months (Pancherz, 1985). In 24
class II subjects treated with the Herbst
appliance (Hansen et al, 1997), the
proclination during treatment was 11°.


Lower Incisor Proclination & general
recession:Large amount of lower incisor proclination during
Herbst treatment could be thought to cause break
down of the labial gingival attachment & create
gingival recessions.
Ruf and Pancherz (1998):
Assessed the effect of orthodontic proclination of
lower incisors in children and adolesctents. The
subjects were treated with Herbst appliance.
Herbst treatment resulted in varying degrees of
lower incisor proclination (mean=8.9°, range=0.5°19.5°).


No inter relation was found between the
amount of incisor proclination and
development of gingival recession. The
conclusion of this study was that in children
and adolescents a temporary orthodontic
proclination of lower incisors seems not to
result in gingival recession.


2. Maxillary molars are moved
distally.
The effect of the Herbst appliance on maxillary
molar teeth is essentially comparable with that
of a high pull headgear (Pancherz, AnechusPancherz, 1993). The teeth are both distalized
and intruded.
Normally, the dental changes occurring during
Herbst appliance treatment would not be
desirable. Distal tooth movements in maxillary
buccal segments could however, be desirable in
cases with anterior crowding

3) Mesial movements of lower molars
4) Sagittal dental arch relationship:
Overjet is reduced in all patients during treatment
by increase in mandibular length and mesial
movement (proclination) of the mandibular
incisors.
 Class II molar correction by increase in
mandibular length, distal movement of maxillary
molars and mesial movement of the mandibular
molars.



Herbst appliance corrects or overcorrects both
molar & canine sagittal relation in most of the
cases. However treatment is more effective in
the molar than in the canine region. This is
probably due to the maxillary anchorage
system, the molar connected to the first
premolar, is pushed distally by the telescope
mechanism (Pancherz and Hansen 1986). The
canine, on the other hand, is not directly
engaged in the anchorage system.


5. Arch perimeter:
Because of the distalizing forces of the
telescope mechanism of the Herbst appliance
on the upper 1st molars and the anteriorly
directed forces on the lower front teeth, the
maxillary and mandibular arch perimeters
increase during treatment. (Hansen et al, 1995)
Arch perimeter changes are, however, of a
temporary nature because settling of the teeth
during the immediate post treatment period.


6. Arch width

Hansen et al (1995) :
During treatment the maxillary and mandibular
dental arches expand laterally in both canine
and molar areas. The expansion is more
marked in the maxilla than in the mandible.


b) Vertical changes
Dental
Skeletal


Dental:
In Class II malocclusions with deep bites, overbite
may be reduced significantly by Herbst therapy
(Pancherz, 1982, 1985) an average of 3.0mm
(55%) during 6 months of treatment.

Overbite reduction is primarily accomplished by
intrusion of lower incisors and enhanced eruption
of lower molars.
Part of the registered changes in the vertical
position of the mandibular incisors results from
proclination of these teeth.
Because of vertical dental changes, maxillary and
mandibular occlusal planes tip down.

Skeletal:
Increase in lower anterior facial height (LAFH)
due to over eruption of lower posterior teeth.

Increase in gonial angle – this may be due to a
more sagittaly directed growth of the condyle
or it may result from resorptive bone changes
in the gonion region, probably as a
consequence of an altered muscle function
during bite jumping (Pancherz & Littman,
1989)

Arji George, V. Surendra Shetty, SN Rao &
Ashima Valiathan:JIOS 1993 studied the
effect of Herbst on certain Orofacial muscles
along with the muscles of mastication.
Experimental Gp: 6 patients with Class II div
1 malocclusion.
Control Gp: 4 individuals with normal
occlusion and acceptable facial balance.
EMG activity of the 5 muscles of mastication
where analyzed at rest, clench, mouth open,
swallowing before and after treatment with
the Herbst appliance.

Results:
1.A change in muscle activity in Class II patients with
respect to control.
Significantly reduced muscle activity of posterior
temporalis, Mentalis and posterior masseter.
Significantly increased muscle activity of the anterior
belly of digastric.
2. A difference in activity before and after treatment.
Increase in activity of anterior and posterior temporalis,
Mentalis.
Decrease in activity of the anterior belly of Digastric.
3. An improvement in muscle activity toward those of
the control group.


The following changes contribute to Herbst
appliance correction of class II malocclusion.
 Stimulation

of mandibular growth.
 Inhibition of maxillary growth (a less important
change)
 Distal movement of upper dentition
 Mesial movement of lower dentition
(proclination of the incisors)


INDICATIONS FOR
TREATMENT
Pancherz (AJO Jan 1985); indicated
that Herbst appliance should be used
only in growing individuals.
Should not be used in non growing
subjects because.
1. Skeletal alterations will be minimal.
2. More of dentoalveolar changes.
3. Increase risk of developing dual bite.

Postadolescent patients:
 Who have passed the maximum pubertal
growth spurt and have still some growth
potential left, treatment with the Herbst
appliance is indicated as it can be finished
within 6 to 8 months.
Mouth breathers: Nasal airway obstructions can
make the proper use of removable appliances
difficult or impossible but doesn’t interfere with
herbst.
Uncooperative patients: It is fixed to the teeth
without any assistance from the patient.
Patients who do not respond to removable
appliances.

For mandibular fracture (particularly
ramus) patients after surgery
For prevention of bruxism
For diseases of the TMJ


TIMING OF TREATMENT
Most favorable time to treat
the patients with the Herbst
appliance is at the peak of
pubertal growth spurt
(Pancherz, Hagg, 1985).
Pancherz & Hagg (1988):
Indicated that the patients
treated at the initial closure of
the middle phalanx of the third
finger (MP3-FG) had the
greatest amount of condylar
growth.

Ruf, Pancherz March 2003, the ideal period
for the herbst appliance treatment is in t he
permanent dentition or just after the pubertal
peak of growth corresponding to the skeletal
maturity stages FG to H of the middle
phalanx (implying the precapping to preunion
stages of epiphysis and diaphysis)
Because mandibular growth stimulation
using the herbst appliance is also possible in
post adolescent young adult subjects, a new
concept of Class II therapy is proposed in
which the Herbst appliance is used as an
alternative to orthognathic surgery in Class II
subjects.

Perfect end result cannot be obtained exclusively
with Herbst.
Class II cases cannot be treated to a perfect end result
with the Herbst appliance exclusively. Many cases will
require a subsequent dental-alignment treatment phase
with a multibracket appliance.
Thus, treatment of a Class II, Division 1 malocclusion will
usually occur in two steps
STEP 1. ORTHOPEDIC PHASE. The sagittal jaw base
relationship is normalized and the Class II malocclusion is
transferred to a Class I malocclusion by means of the
Herbst appliance.
STEP 2. ORTHODONTIC PHASE. Tooth irregularities
and arch discrepancy problems are treated with a
multibracket appliance (with or without extractions of
teeth).

A Class II, Division 2 malocclusion may
require a three-step treatment approach
STEP 1. ORTHODONTIC PHASE. Alignment
of the anterior maxillary teeth by means of a
multibracket orthodontic appliance.
STEP 2. ORTHOPEDIC PHASE.
Normalization of sagittal jaw base
relationships and transformation of the Class
II malocclusion into a Class I malocclusion by
means of the Herbst appliance.
STEP 3. ORTHODONTIC PHASE. Tooth
irregularities and arch-discrepancy problems
are treated with a multibracket appliance (with
or without extractions of teeth).

So the ideal patient for treatment with the
Herbst appliance has the following
characteristics:
Skeletal morphology.
• Retrognathic mandible.
• Small mandibular plane angle indicating an

anterior growth direction of the mandible.
(A favorable growth pattern both facilitates
treatment and counteracts post treatment
relapse.)
• Normal or reduced lower facial height.

Dental morphology:
 Class II dental arch relationship with
increased overjet and normal or increased
overbite (open bite cases not suitable for
Herbst appliance).
 Maxillary and mandibular teeth well aligned
and the two dental arches fitting each other in
normal sagittal position
Maturation:
 Treatment during pubertal growth spurt.


Types of Herbst Appliance
The original design since the seventies
has maintained its general shape with
only a few modifications taking place
with regard to methods of application
(Type I, II and IV).


Type I is characterized
by a fixing system to
the crowns or bands
through the use of
screws. This is the
most common form. It
is necessary to weld
the axles to the bands
or crowns and then fix
the tubes and plungers
with the screws.


Type II has a fixing system
that fits directly onto the
archwires through the use of
screws. This method of
application has the
disadvantage of causing
constant fractures in the
archwires due to lack of
flexibility together with the
difficulty in lateral
movements and the stress
placed on the archwires
through activation.


Type IV has a fixation system
with a ball attachment, which
allows greater flexibility and
freedom of mandibular
movement.
A disadvantage in relation to
other similar appliances is the
fact that it needs brakes to
stabilize the joint. These
brakes are small and
sometime difficult to fit.


MODIFICATIONS OF THE HERBST
APPLIANCE
 In

patients with class II
malocclusions who have
narrow maxillary arches,
expansion can be
performed using the
Herbst appliance by
soldering a quad helix
lingual arch wire or a rapid
palatal expansion device
to the upper premolar and
molar bands or to the
splint.

The cast splint herbst
The bands are replaced by splints, cast
from cobalt-chromium alloy and
cemented to the teeth with GIC. The
upper and lower front teeth are
incorporated into the anchorage through
the addition of sectional arch wires. The
cast splint appliance
ensures a precise fit on the teeth
is strong and hygienic
saves chair time
Causes very few clinical problems

Herbst with stainless steel
crowns
Norris M. Langford,
1982 JCO) suggested
using stainless steel
crowns on the upper first
molar and the lower first
premolar and canine for
which are superior to
banding, in that they are
resistant to breakage and
becoming loose.

MODIFICATIONS:
the

substitution of stainless steel
crowns for bands.

the

elimination of the stabilizing
bar.


The bonded Herbst appliance
(1982)
The bonded Herbst appliance
eventually evolved into the acrylic splint
Herbst appliance (McNamara, 1988;
McNamara and Howe 1988).
The acrylic splint Herbst appliance is
composed of a wire framework over
which has been adapted, 2.5-3.0 mm
thick splint Bioacryl, using a thermal
pressure machine

By substituting an acrylic
splint for the stainless
steel bands of the earlier
appliance, the Herbst
mechanism can be
attached to both maxillary
and mandibular arches
using bonding procedures


The maxillary splint
covers all available
maxillary teeth with
exception of the
central and lateral
incisors
The occlusal thickness
of the maxillary splint
is kept to a minimum,
so that the cusps of
the posterior teeth
perforate the splint

These perforated
openings permit the
placement of the nylon
tip of a posterior bandremoving plier against
the cusps.


Disadvantage of Banded Herbst:
I)

II)

III)

IV)

Repeated breakage and loosening of the
appliance occurs, especially in the lower
bicuspid band area.
Rapid intrusion if the mandibular first
bicuspids which though temporary, partially
deactivates the appliance.
As the bicuspids are depressed, the lingual
arch is also depressed, resulting in
impingement on the lingual gingiva.
Possibility of incisal tooth fracture.

Headgear – Herbst appliance : Weislander (1984)
Wesilander suggested the use of special
headgear – Herbst appliance in the treatment
of large sagittal discrepancies between the
maxilla and mandible in early mixed dentition.
The Herbst appliance consisted of a cast of
vitallium bonded to the lower arch and with
bands on the upper first permanent molars.
The upper bands were united with a palatal
bar and connected to the lower splint with the
Herbst telescopic arms.

He concluded that a
short period of
interceptive orthopedic
treatment in the very
early mixed dentition
may be indicated to
correct skeletal
deviation and establish
a normal relationship
between maxilla and
mandible.

Cantileverd Herbst
appliance
This was a design given
by Larry W. White, 1994.
Cantilever Herbst design.
Buccal cantilever wire is
made by doubling .045"
wire and soldering the two
strands together.


Advantage :
 This

design is
particularly useful
when mandibular
bicuspids are
absent or the
primary molars
cannot withstand
functional forces.


Modified Herbst appliance for the
mixed dentition
Introduced by Philip Goodman and Paul
Mc Kenna, 1985
They stated the middle phalynx
development may, indicate optimal
treatment timing, but the patient’s
bicuspids are not erupted enough to
receive either bands or crown.
Also they encountered a modification
where stainless steel crowns are fitted on
the upper first permanent molars and
bands on the lower first molars and
incisors.

The deciduous first and
second molars are free to
exfoliate through the
framework

If the patient is uncomfortable
with much mandibular
advancement, have the patient
retrude the mandible until the
discomfort disappears. The
telescopic part of the
appliance can be advanced
again in six to eight weeks
using washers or metal
sleeves.


The EMDEN Herbst – a fixed removable
Herbst appliance. Tarek Zreik 1994
Introduced by Tarek Zreik, 1994 to
overcome breakage problems, he
had with the Herbst appliance.
This modification makes the
Herbst more durable, simple and
hygienic.


The Herbst mechanism is
attached to stainless steel
crowns on the maxillary
first permanent molars and
to the lower arch through a
removable acrylic splint.
Double buccal tubes on
the stainless steel crowns
can hold utility, sectional,
or continuous archwires.


Advantages of the EMBDEN Herbst
• It requires minimal cooperation.
• It promotes patient acceptance because it is not
visible and it produces an immediate improvement
in the profile.
• It allows more cases to be treated without
extractions.
• It is easy to construct, fit, adjust, and clean.
• Materials are inexpensive, and breakage is
minimal after a modest amount of laboratory
experience is gained.
• The lower splint increases anchorage, thus
providing more of a skeletal correction, and
restricts forward movement of the lower incisors.

Edgewise Herbst
Appliance
This design was given by Terry Dischinger, 1995


The Edgewise Herbst Appliance
corrects Class II malocclusions rapidly
and without the need for patient
cooperation. It allows orthodontic tooth
movements during orthopedic
correction and a smooth transition from
Herbst treatment into the edgewise
finishing appliance. The new appliance
is more clinically efficient than previous
models and is easily incorporated into
an edgewise practice.

Herbst with Mandibular
Advancement Locking Unit
Components (MALU)
 2 tubes
 2 plungers,
 2 upper “Mobee”
hinges with ball pins
 2 lower key hinges
with brass pins


In the upper arch of
the edgewise-Herbst
MALU appliance,
only the first molars
are banded, with .
051" headgear tubes.
A palatal arch can be
used in cases of
overexpansion.


In the lower arch, the first
molars are banded, and the
anterior segment is bonded from
cuspid to cuspid with .022"
brackets. The bicuspids may be
left unbracketed to help in settling
the occlusion and locking in the
mandible.
The mandible can be
progressively advanced using
1-5mm spacers.


Advantages:
1. Its cost is considerably lower because it

requires no laboratory construction.
2. Its simplicity makes it useful even for non-

growing patients in whom only dental
movement and mandibular repositioning are
required.
3. It can also be used in growing patients who

have not cooperated with removable
appliances or headgear.


Flip-Lock Herbst
Appliance
A new design, the FlipLock Herbst appliance,
reduces the number of
moving parts that can
lead to breakage or
failure. It is easy to use
and more comfortable
for the patient than the
conventional cantilevertype Herbst. Instead of a
screw attachment, it has
a ball-joint connector,
and it needs no
retaining springs.

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


In the second
generation, the
plastic was replaced
with metal


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

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

The Jasper Jumper :
This interarch flexible force module
allows patient greater freedom of
mandibular movement than is possible
with the original bite jumping
mechanism of Herbst. Dr. James
Jasper in 1987


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

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

Principle of action :
When the force
module is straight, it
remains passive. As
the teeth come into
occlusion the spring
of the force module
is curved axially
producing a range
of forces from 1 to
16 ounces.

If properly installed to produce mandibular
advancement, the spring mechanism is curved or
activated 4 mm relative to its resting length, thus
storing about 8 ounces (250g) of potential for force
delivery.
If less force is desired (eg force levels that produce
tooth movement alone), the jumper is not activated
fully.
Increasing the activation beyond 4 mm does not
yield more force from the module but only builds
excessive internal stress.

Anchor units :
A number of
methods are
available to anchor
the force modules to
either the
permanent or mixed
dentitions.


Attachment to the main
arch wire :
Dr. Jasper `s method.

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


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

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

Replacement of a broken jumper required
removal of the entire archwire.
If an arch breaks or comes untied at the
distal tieback, all the force is transferred to
the anterior teeth, which tends to tip them
forward depress them and open space.
Removing the Jumper for an occlusal
check is time consuming.
In an extraction case, it is difficult to close
spaces because the jumper must be
attached to the arch before closing loops.

2. Dr. Cope’s Method :
Dr. Don cope makes
an attachment out of
an 0.017 x 0.025”
stainless steel wire,
soldered to a rocky
mountain lock, then
bent so as to pass
distal to the lower first
molar. The lock is
attached between the
bicuspid and cuspid


An alternative is to
place the lock distal
to the molar bracket
with the wire bent
distal to the cuspid.
The approach uses
a free sliding quick
connect (figure).
The wire runs
parallel to the main
archwire, allowing
the jumper to clear
the bicuspid
brackets.


Advantages :
The attachment can be made in the office
laboratory, and placement can be delegated to
an assistant.
The jaws can open fully.
Force is directed distal to the molar; if the
archwire breaks there is no effect on the
anterior teeth.
The jumper does not interfere with space
closure or leveling procedures. A broken
jumper is easy to replace.
No auxiliary tubes are needed on the
mandibular molars.

Disadvantages :
Laboratory time is required to solder
and bend the attachment.
The rocky mountain lock assembly is
an additional expense.


2) Attachment auxiliary
archwire :
Incorporates the use of “out
rigges” which are 0.016 x
0.022” (0.018” slot) or 0.018
x 0.025” (0.022” slot)
auxiliary sectional wires.
The sectional arch is looped
over the main archwires
anteriorly between the first
premolar and canine.
Posteriorly into the lower first
molar band.

The sectional archwire must have
adequate clearance from the alveolus
and gingiva to avoid tissue
impingement.
Advantages :
Has all of the previous said advantages
plus
The clinician may leave the premolar
bands in place
Materials are in expensive.


Attachment in the Mixed
dentition
The maxillary attachment is as
the original attachment.
The mandibular attachment
includes an archwire that extends
from the brackets on the lower
incisors, posteriorly to the first
permanent molars, by passing
the region of the deciduous
canines and molars.
In a mixed dentition patient the
use of a transpalatal arch and
fixed lower lingual arch is
mandatory to control potential
unfavorable side effects.

Divided into 3 phases as
advocated by Dr. Jasper
Leveling and anchorage
preparation
 Period of jasper jumper use (6-9
months)
 Period of finishing (12 months)



Leveling and anchorage
preparation
Alignment of the maxillary and mandibular
anterior teeth during the initial phases of
orthodontic treatment must be completed.
Full-sized (or nearly full-sized) archwires
should be inserted into the brackets in both
arches before the placement of the force
modules.
The archwires should be tied or cinched back
posteriorly to increase anchorage, including
second molars whenever possible.
In addition, the clinician can place posterior
tip-back bends in the mandibular archwire to
enhance anchorage.

Anterior lingual crown torque can be
placed in the arch wire. Alternatively lower
incisor brackets with 5 degrees of lingual
crown torque incorporated into the slot
also can be used to prepare anchorage.


Preparation of the arches :
After the full sized arch wires have become
passive, the mandibular arch wire is
disengaged and the brackets on the 1st and
2nd premolars are removed bilaterally.
Unless on triggers are used, bayonet bends
are placed in the archwire distal to the lower
canine bracket, and 3 mm Lexan beads are
slipped over the ends of the arch wire and
moved forward to rest against the bayonet
bends bilaterally.

Selection and
installation of the
modules

Determination of proper
length of force module.
Twelve millimeters are
added to measurement of
distance between mesial
aspect of face-bow tube and
distal aspect of Lexan ball. In
this example, distance from
ball to face-bow tube is 20
mm. Thus 32 mm module
should be selected.


The lower arch wire in threaded through the hole
in the anterior end cap of the force module,
ligated in place and the ends of arch wire are
cinched or tied back firmly.
Then the ball pin is inserted through the face
bow tube on the maxillary first molar band from
distal to mesial and cinched forward.
In-patients with high mandibular plane angle the
pin is cinched to achieve approximately 2mm of
module deflection (150g / side).
In patients with low or normal mandibular plane
angle, the ball pin is cinched forward to achieve
4 mm of module deflection (300g force/ side).

The patients are coached to practice
opening and closing movements slowly at
first and told to avoid excessive wide
opening during eating and yawning.


Activation of the module for
orthodontic and orthopedic
effect :
If molar distalization is desired. The jumper
is placed so that only 2-4 ounces of force is
produced by the module.
In growing patients in whom orthopedic
repositioning of the mandible is desired,
higher forces (6 - 8 ounces) are used
continuously.


Reactivation of the
module :

If the class II molar relationship is not corrected
completely by the initial activation, the modules
should be reactivated 2 – 3 months later.
The pin extending through the face bow is pulled
anteriorly 1-2 mm on each side to reactivate the
module.
2-4 mm of the pin should extend distally when the
pins are activated maximally (so that the jumper
does not blind against the distal aspect of the face
bow tube.)

Ball pin protrudes 2-3mm distally, allowing free movement. B. Ball
pin too close to molar tube, which can cause breakage of ball pin or
Jumper. C. Correct placement. Anterior force is delivered distal to
lower molar bracket, while depressing force is delivered to archwire
between cuspid and bicuspid.

Activation of the force module can also
be made by crimpable stops (1 –
2mm) placed mesial to the lexan
beads.
It is more accurate
Easier to perform
Avoids unintentional restriction of ball
pin / molar tube relationship


Types of forces
produced :
Bilateral directions of
force generated by the
modules include
sagittal, intrusive and
expansion forces.
Force module curves to
buccal, producing
shielding effect on
dentition.


Buccal force → due to intrusive force acting
along the buccal surfaces of the maxillary
teeth → produces maxillary arch expansion.
Modules curving outwards → Vestibular
shielding effect
Expansion forces can be minimized or
eliminated through the use of a transpalatal
arch or a heavy arch wire that has been
narrowed and to which buccal root torque
has been applied.


Treatment effects :
Maxillary adaptations :
i) Headgear effect :
One treatment effect produced most easily is
distalization of the upper posterior segment or the
headgear effect.
 For this the maxillary arch wire must not be cinched
or tied back, but remain straight and extend past the
buccal tubes.
 Involves light forces (2-4 ounces)
 Minimal changes in the mandibular dentition.
 This effect can be produced in actively growing as
well as adult patients.



Retraction of anterior
teeth
Upper canines alone or all the
six anterior teeth can be
retracted in both extraction and
non-extraction patients with a
NiTi coil or an intramaxillary
elastic, with the posterior
maxillary dentition supported
by the force module.
Cuspid retraction mechanics:
As Jumper pushes ball pin
distally, molar anchorage is
maintained and cuspid is
retracted along archwire.


Maxillary anterior
teeth are retracted as
a unit by attaching
ligature to
appropriate archwire
tiebacks.


Dental Asymmetries
The force module system also can be
used in-patients who have sagittal
dental asymmetries.
In a patient with a class II subdivision
type of malocclusion the maxillary
archwire orthopedic effects may also
be achieved.
Asymmetric orthopedic effects may
also be achieved

Mandibular
Adaptations :
In producing mandibular advancement
the movement of maxillary posterior
dentition must be cinched or tied back.
Also a transpalatal arch must be
placed, to obtain intra arch anchorage.
Level of force generated is higher (6 to
8 ounces ) than for headgear effect.

Jasper’s theory of two’s” suggests that class II
correction with Jasper jumper therapy can be
equally proportioned between 5 components.
1. 20% due to maxillary basal restraint
2. 20% due to backward maxillary dent alveolar
movement
3. 20% due to forward mandibular dentoalveolar
movement
4. 20% due to condylar growth stimulation
5. 20% due to downward / forward glenoid fossa
remodeling

Jay Bowman JIOS 2001 reported the use of
jasper jumper in a 13year old female with
class II division1 malocclusion and moderate
overjet, after 5 months an anterior end on
relation was noted.
They concluded that lingual tipping of
maxillary incisors along with mandibular
growth assisted to correct the overjet.
There was labial tipping of 91 to 98 degrees
so lingual crown torque on mandibular incisor
was advised to prevent this adverse reponse
with jasper jumper.

Nalbantgil D, Arun T, Sayinsu K, Fulya I
Angle Orthod 2005 studied 15 subjects (class
II) treated with jasper jumper and compared
them with15 untreated(class II) subjects. They
were late adolescent patients.
Results: Class II discrepancies were mainly
corrected by dentoalveolar changes and this
could be an alternative method to orthognathic
surgery in borderline class II cases.


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

. Piston fitted to
the cylinder of a
MARS
appliance.


• Allignment must be complete.
•

The teeth in the respective arches
should be aligned, with correct axial
inclinations, prior to attachment of
the appliance.

•

The MARS appliance should be
attached only to the heaviest
rectangular arch wires that can be
accommodated by the brackets and
tubes. The heavy arch wire
prevents breakage at the point of
attachment as well as excessive
intrusion in the region of the
mandibular canines.

•

The mandibular arch wires should
be securely tied back to the terminal
molar before attachment of the
MARS appliance.

Failure to do this will usually result in
flaring of the lower incisors, even with
the heavy rectangular arch wire, since
the untied arch wire will slide forward
through the tubes and brackets of the
posterior teeth. Previously closed
mandibular extraction spaces are likely
to reopen if this precaution is not taken.


Determining length
of assembly
With the patients protruding the mandible into
a class I position, the right and left strut
lengths are measured.
The MARS strut length is that distance from
the middle of the interbracket space distal to
the lower canine to the middle of the
interbracket space mesial to the maxillary
terminal molar.

The upper member or hollow tube length is
determined by subtracting a calculated and
standardized measurement of 7.4mm from the strut
length.
The free end of the lower member or the plunger is
then cut so that 2mm extends out of the back of the
upper member
One reference measurement needed for this
appliance is the PIED (Protrusive incisial edge
distance) PIED is the horizontal distance measured
at the midline between the maxillary and mandibular
incisial edges with the mandible in its maximum
strained protruded position.


The MARS appliance should be locked into
position with the mandible 2 to 3 mm posterior to the
maximum PIED measurement. In the event a patient
encounters muscular discomfort as a result of
protruding the mandible too far forwards the
appliance is adjusted and locked in a less protrusive
position.
At subsequent appointment the Pied should be
measured and recorded. The authors have observed
that the PIED will increase from 0.5 to 2 mm between
3 to 4 week appointment intervals. When the PIED
ceases to increase between appointments, the
MARS appliance is then adjusted so that a super
class I occlusal relationship is obtained.



Two methods to lengthen the appliance
 1)

Replacement of the struts with longer upper
members of cylinders.
 2)Placement of spacers 2 to 3 mm in length on the
lower members or pistons.

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

Disadvantages :
Need for a fixed multi-banded appliance
limits its use in mixed dentition cases.
Disarticulates the posterior segments
from 1 to 3 mm
Needs to customize the appliance for
each patient.


Mandibular Protraction
appliances :
This appliance was
developed by Carlos
Martin Coelho Filho (JCO
1995).
His inability to purchase
some of the newer class II
corrective appliances in
northern Brazil led him to
develop these group of
appliance that reposition
the mandible forward.


They have proven effective in treating Class
I patients with exaggerated overjets and
Class II subdivision patients where only one
side needs correction.
Their advantages include ease of
fabrication, low cost, infrequent breakage,
patient comfort, and rapid installation.
But they are not claimed to be superior but
are only treatment alternatives to Class II
therapies.

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


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

Functioning of the appliance
MPA -1
Appliance slides distally along
mandibular archwire and
mesially along maxillary
archwire upon opening.
But frequent dislodgment
of molar bands led Filho to
develop the 2nd protraction
appliance. (MPA n.o 2)


MPA No. 2
MPA No. 2 is made
with right-angle circles
in two pieces of .032"
stainless steel wire.
Coil of .024" stainless
steel wire is slipped
over one wire.
Travel of each wire is
limited by wire coil.

Improper relationship of
wires is prevented by coil.
Maxillary archwire has
occlusally directed circles
against molar tubes;
mandibular archwire has
occlusal circles 2-3mm distal
to each cuspid.




Advantages :
Easily fabricated at chair side, with
ordinary inexpensive wires.
Do not require any special bands ,
crowns or wire attachments.
No impression or wax bite
registrations are needed.
Easily inserted adjusted,removed
and can be made and installed in
about 30 minutes.
Much smaller and thus more
comfortable.
Permit a greater range of motion
and are less restrictive of movement

MPA-3
CARLOS M. COELHO FILHO,(JCO
2001)

Many of the limitations of the
first two MPA designs have
been overcome with the
development of the MPA No. 3.
This version eliminates much
of the archwire stress and
permits a greater range of jaw
motion while keeping the
mandible in a protruded
position.


Appliance
construction
The parts needed for the
construction of the MPA No. 3
are:
Two maxillary tubes of 0.045”
internal diameter each about
27 mm long.
Two maxillary loops of 0.040”
stainless steel wire, each
about 13 mm, long, with a
loop bent into one end at an
angle of about 130 to the
horizontal.
Two mandibular rods of
0.036” stainless steel each
about 27 mm long.

Annealed pin bent mesial to the
molar tube


MPA No. 3 reversed for
Class III treatment, with
open-coil spring
between appliance tube
and rod loop.


Advantages of MPA n.o 3
over the previous
models :
More comfortable for the patient
Offers greater range of motion
Equally simple and inexpensive but easier to
place
Adaptable to either class II or class III cases
Can be used for mandibular positioning or
dento alveolar movement
Causes less breakage.


MPA IV
The latest version, the
MPA IV,** is much
easier to construct and
install, and much more
comfortable for the
patient. The MPA IV is
made up of the
following parts:
• “T” tube
• Upper molar locking
pin
• Mandibular rod
•Mandibular archwire

Piece of .040" stainless steel
wire is inserted into longer
tube to prevent
deformation while bending
molar locking pin with
finger pressure.

Molar locking tube is then
cut and annealed to make it
easy to bend during
installation.


Mandibular rod
inserted into “T”
tube.

This fourth version seems to
be as efficient as its
antecedents, but is much more
practical to construct, easy to
manipulate, and comfortable
for the patient.

Adjustable Bite corrector
(ABC) (JCO 1995)
Introduced by Richard P. West
The appliance essentially
consists of:
A stretchable closed coil spring
and internally threaded end cap
nickel titanium wire in the
centre lumen of the spring.
The closed coil spring is made
of 0.01 8” stainless steel, and
will stretch to about 25%
beyond its original length
without permanent deformation.

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

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


Nickel titanium wire
is replaced and end
caps unscrewed to
add appliance length.


Repairs and emergencies :
 Wire

fractures are infrequent with the ABC.
 Repair is easy, where the end caps are
unscrewed and the coil spring or nickel
titanium wire is replace with a new one
from the kit.


The ABC can be used for upper molar
anchorage control during retraction of
anterior teeth for space closure.
The class II “push” force of the ABC
creates full time maximum anchorage at
the upper molars while bringing the
lower posterior teeth forward form the
pull at the jig attachment.

The Eureka Spring (JCO
1997)

Introduced by John De Vincenzo
The main component of the
Eureka spring is an open wound
coil spring encased in plunger
assembly
The ram is made from a special
work hardened stainless steel
that has been precision machined
with 3 different radii.
At the attachment end the ram
has either a closed or an open
ring clamp that attaches directly
to the archwire.


The essential aspects
include spring
module A, molar
attachment tube B,
push rod C, free
distance D, molar
attachment wire E,
free distance F.


A triple telescoping action permits the mouth
to open as wide as 60 mm before the plunger
becomes disengaged.
The cylinder assembly is connected to a
molar tube with a an 0.032” wire that has
been annealed at the anterior end.
An 0.036” solid ball at the posterior end acts
as a universal joint, permitting lateral and
vertical movements of the cylinder.
The Eureka spring comes in only 2 sizes one
for extraction and one for non-extraction
cases and left and the right sides are
interchangeable.

Advantages

It has esthetic acceptability because of its small size
and lack of protuberances into the buccal vestibule, as
it is almost invisible.
Resistance to breakage: produces forces of only 140g170g at the points of attachment as compared to 220280g of Jasper Jumper.
Ability to produce rapid movement : this is in spite of its
low force levels because the Eureka spring continues to
work even when the mouth is opened as much as 20
mm as when sleeping or when the mandible is thrust
forward as far as 10 mm, in an attempt to minimize the
force.
Ease of installation
No auxiliary archwires or extra impressions for
laboratory fabrication are needed.

Low cost : similar in cost to the jasper jumper
but less expensive than the fixed Herbst
appliance.
Minimal inventory requirement
Optimal direction of force
Delivers a push force against mandibular
anterior and maxillary posterior teeth.
It also has a vertical intrusive component at the
maxillary molars and mandibular although this
is minimal due to direct archwire attachment,
rather than via auxiliary wire.

The churro jumper (JCO
1998)

Introduced by Ridhardo Castanon,
Mario S Valdes and Larry White.

The Churro Jumper furnishes
orthodontists with an effective and
inexpensive alternative force system
for the anteroposterior correction of
class II and class III malocclusions.
It was developed as an improvement
of the MPA of Coelho.
Although the churro jumper was
conceived as an improvement to the
MPA, it functions mere like a Jasper
Jumper.

Construction :
The Churro Jumper requires a
series of 15-20 symmetrical
and closely placed circles,
formed in a wire size of .028"
to .032".
Since the Churro Jumper
requires reciprocal anchorage,
Generally, the largest possible
edgewise archwire is the best
to use. This will usually be
an .018" X .025" archwire, or .
0175"X .025". Any wire
smaller than these invites
breakage.

Churro needs space to
slide on the mandibular
archwire, at least the
first premolar brackets
should be omitted. It is
usually advantageous to
place a buccal offset in
the wire just distal to the
canine bracket so that
the jumper also has
buccal clearance, which
permits unrestricted
sliding along the wire

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


Mode of action :
In its passive form, the
churro is not flexed
However when the pin is
pulled forward enough to
cause the jumper to bow
outward the cheek, the
appliance begins to exert
a distal and intrusive
force against the
maxillary molar and a
forward and intrusive
force against the incisors
as it attempts to
straighten.

Unilateral / Bilateral use :
This jumper can be used unilaterally in cases
of class II subdivision malocclusions.
The bilateral class II churro jumper is most
suitable for patients who need mandibular
incisors advancement. Not a very good
choice for class II bimaxillary proclination
cases.
By reversing the attachments, the churro
jumper can also be used to treat class III
malocclusions.


Advantages :
Provides a constant, indefatigable force.
Can be used either unilaterally or
bilaterally.
Can be used in class II or class III cases.
Helps maintain anchorage.
Very inexpensive.
Can be constructed from commonly
available materials universal in size.
When broken, it is easily replaced.
Staff members can quickly learn how to
replace an appliance.

Disadvantages :
Restricts the mouth opening to 30-40 mm
Archwire breakage is seen if larger wires not
used.
Patients with a low tolerance for discomfort will
often break the appliance.
Patients who incessantly move their mouths
while chewing, talking and nervous tics will fare
poorly.
Its maximum effectiveness depends on a
permanent dentition to retain its effect.
It must be manufactured in the office.


The universal bite jumper
(JCO 2001)
Introduced by Xavier Calvez
This is a fixed functional
which can be used in all
phases of treatment, in the
mixed or permanent dentition
and with removable or fixed
appliances.
This jumper also uses a
telescoping mechanism, can
also have an active coil
spring if necessary.


Fixed appliance configuration

In the mandibular arch, the sliding rod ends in a 90° hook that is
fixed to the archwire.


UBJ ATTACHED TO
AUXILLARY WIRE


Lower cantilever configuration

The UBJ tubes are welded to the maxillary molar bands or
crowns. .
The UBJs are adjusted while mandibular movements are
checked.
Depending on the case, the brackets can be bonded during the
same visit or a few weeks later.
The advantage of this configuration is the possibility of
immediate orthopedic action without waiting for dental
alignment.

Removable splint mounting

When used with removable acrylic splints, two lateral
UBJs link the maxillary molar areas and the mandibular
first premolar areas. They are attached to 1.2mm ball
clasps, which are constructed on the working cast and
then incorporated into the thermoformed splints.

Single median UBJ
A single median UBJ can
be used to link the
removable splint from the
middle rear area of the
palate to the lingual
surface of the mandibular
incisor.
The UBJ is attached to
two transverse axles,
which allow opening and
lateral movements.

The median UBJ provides muscular
therapy as it prevents the tip of the
tongue from contacting the lower lip.
Most children are able to speak well
with this appliance, given a little time to
adjust. Cheek impingement is
eliminated and it is the author’s
experience that the tongue is not
irritated with this design.


Adjustments :
Reactivation are made
every 6 to 8 weeks by
crimping 2 to 4 mm splint
bushings on to the rods.
Midline or
asymmetrical problems
can easily be treated by
adjusting one side or other
of the appliance.

Advantages
It is simple, sturdy, and inexpensive.
Inventory requirements are minimal--the UBJ
can be used on either side of the mouth, and
there is only one size, since it is cut to the
desired length for each case.
It can be used at any stage of treatment --in
the early mixed dentition to obtain an
immediate mandibular advancement before
any dental alignment, or in the permanent
dentition for fixed functional treatment.

It can be used in Class II or Class III cases.
Its low profile results in considerably less
buccal irritation than with similar appliances.
Patient comfort and acceptance are
excellent.
It can easily be attached to removable splints
for maximum anchorage.
It produces good results without the need for
patient cooperation


The saif Spring
(Severable Adjustable inter maxillary force)
First interarch force system developed by
Armstrong
In the later 1960’s and early 1970’s he
introduced the Pace Spring, later termed
multicoil spring and finally called Saif spring.
These were first marketed by North West
orthodontics, later by Unitek, and currently by
Pacific coast manufacturing.
They consist of two springs one inside the other
with soldered loops on each end.

Various attachments can be placed through these
loops to secure the springs to deliver either class II or
class III force.
They are available in 7 mm and 10 mm lengths, have
an outside diameter of 3 mm, and deliver 200 to 400
gms of force.
Breakage is a constant problem.
Bit bulky, not very hygienic and there is some
limitation to mandibular opening
However large forces are generated by these springs
which may account for the surprisingly rapid
correction observed.

The Ritto Appliance
The Ritto Appliance
can be described as
a miniaturized
telescopic device
with simplified
intraoral application
and activation


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


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


The Magnetic Telescopic Device
Ritto A.K. in 1997
This consists of two tubes and two
plungers with a semi-circular
section and with NdFeB magnets
placed in such a manner that a
repelling force is exerted.
Fitting is achieved by using the
MALU system.
This appliance has the advantage
of linking a magnetic field to the
functional appliance. Its main
disadvantages are its thickness,
the laboratory work necessary to
prepare it and the covering of the
magnets.

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

Drawbacks:
The major drawback of
this appliance is the
difficulty to control the
force.
May create discomfort
and impingement
problems.
Is recommended only for
permanent dentition.


ALPERN CLASS II CLOSERS
It is one of the most recent.
It is predominantly applied in
Class II correction and as a
substitute for elastics.
It consists of a small telescopic
appliance with an interior coil
spring and two hooks for fixing
It functions in the same way as
elastics and, similarly, is fixed to
the lower molar and to the upper
cuspid.
It is available in three different
sizes. Its telescopic action
enables a comfortable opening
of the mouth.

Mandibular Corrector (JCO
1985)
Introduced by Marston Jones
It is a fixed functional that uses
bilateral piston and plunger
telescopic mechanism to
reposition the mandible
anteriorly and is directly
attached to archwires of a
multibanded fixed appliance.
Connectors holding the
repositioning arms are attached
to the archwires distal to the
lower cuspid brackets and
mesial to the tubes on the
terminal upper molars.

 The

length of the repositioning arms are
determined intraorally with the patient’s
mandible advanced 3-4 mm.
 The entire procedure can be completed at
chair side in 30 minutes.
 The mandible can be advanced in small
increments of 2-4 mm at 4 week intervals until
the incisors are in an edge to edge relationship.
 Midline corrections are made by advancing the
appliance more on one side.
 A correction of 3-4 mm can be achieved within
6 months, an overjet of 7 to 8 mm may require
12-14 months.

The Horizontal Anterior
Positioning (HAP) appliance

Most of the appliances have
anterior contact while allowing
for posterior eruption.
Unfortunately, the lack of
posterior support has been
shown to have a loading effect
on the TMJ.

Dr. William B. Farrar recognized
the need for posterior support
and modified the original Sved
appliance to incorporate two
posterior acrylic pads along with
an anterior ramp.

Components of HAP appliance: A. Anterior
reverse ramp. B. Sagittal screws. C.
Expansion arms. D. Coffin spring. E. Locking
mechanism.
Anterior reverse ramp

Expansion arms
Sagittal screws

Locking mechanism

Coffin spring

A lower "dipod, which
provides upper and lower
posterior occlusal support.
A posterior pad can be
added to the HAP, but
adjustments become more
difficult and the possibility of
breakage increases.
The vertical dimension can
be increased if necessary.
The bite-opening effect
allows for passive or active
eruption of the posterior
occlusion to help level the
curve of Spee.

The Mandibular Anterior
Repositioning Appliance(MARA)
These interference’s are produced when a
horizontally adjustable vertical bar attached
to the buccal surface of a maxillary first
molar stainless steel crown, hits a buccally
protruding horizontal bar extending from the
lower first molar stainless steel crown.
Additional activations can be made by
placing one or more shims at the mesial
aspect of the horizontal bar.
Advancing the mandible forward in precise
increments can be achieved by insertion of
selected shims of varying length.

Advantages over Herbst
Better esthetics
Problem with disengagement do not occur
Breakage from lateral mandibular movements
should be less.
Can be used concurrently with full edgewise
orthodontic appliance.
This
Eliminates the need for a 2 phase treatment.
 Can maintain the achieved orthopedic results, since
the appliance can continue in a non activated
manner.



Disadvantages
Temporary stainless steel crowns needed on
all first molars.
Some increase in anterior facial height
results from the placement of these crows.
Fabrication only available at one commercial
laboratory.
The posterior and buccal location of the
guide planes may cause loosening of the
stainless steel crowns or breakage of the
mandibular protruding horizontal bar.

Pangrazio-Kulbersh V, Berger JL, Chermak DS,
Kaczynski R, Simon ES, Haerian A,Ajo 2003,. The aim of
this study was to investigate the MARA's dental and
skeletal effects on anterior, posterior, and vertical
changes in 30 Class II patients.
The treatment group consisted of 12 boys with an
average age of 11.2 years and 18 girls with an average
age of 11.3 years.
A pretreatment cephalometric radiograph was taken 2
weeks before treatment, and a posttreatment
cephalometric radiograph was taken 6 weeks after
removal of the MARA, with an average treatment time of
10.7 months. The mean and standard deviation were
calculated for each cephalometric variable, and Student t
tests were performed to determine the statistical
significance of the changes.


The results of the study showed that the MARA
produced measurable treatment effects on the
skeletal and dental elements of the craniofacial
complex.
These effects included a considerable distalization of
the maxillary molar, a measurable forward movement
of the mandibular molar and incisor, a significant
increase in mandibular length, and an increase in
posterior face height.
The effects of the MARA treatment were then
compared with those of the Herbst and Frankel
appliances. The treatment results of the MARA were
very similar to those produced by the Herbst
appliance but with less headgear effect on the maxilla
and less mandibular incisor proclination than
observed in the Herbst treatment group


Kinzinger,Ostheimer, Diederich,2002
It has a propulsive mechanism that
resembles the Mandibular anterior
repositioning appliance, but differs in
its mode of action and intraoral
activation.
It relies on the principle of inclined
planes that are placed in the buccal
corridor spaces that will not hinder
swallowing or articulation.
The protrusion guide pins are fitted
to the upper portion of the apliance at
a 60 degree angle to horizontal,
ensuring active, forward mandibular
guidance during even partial jaw
closure.

Reactivation in the sagittal plane
is done simply by moving the
guide pins to a more forward
threaded support sleeve. This
gradual activation allows
patients particularly adults to
adjust to the appliance.
Kinzinger, Diederich JCO 2005
reports the use of FMA in a 16
year old male with Class II div2
and for just 3 months the patient
was able to protrude the
mandible significantly forward
from the therapeutic position.

Advancement in
therapeutic positions

Maximum protrusion of
mandible after 3 months


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

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


Advantages
Can be used concurrently with banded
treatment.
Esthetic benefit
Capability of adjusting the amount of protrusive
activation.
Disadvantages
Potential for more breakage and loose crowns
Greater cost.
Need for crowns on molars

The Klapper Superspring II

Introduced by Lewis Klapper in
1997, for correction of class II
malocclusions.
On first glance, it resembles a
Jasper Jumper with a substitution
of a cable for the coil spring. In
1998 the cable was wrapped with
a coil and the Klapper superspring
II was the result.
Only two sizes are required (left
and right sides are not
interchangeable) and breakage is
less frequent.
However it differs significantly from
the Jasper Jumper at the molar
attachment.

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


Disadvantages
Requirement of a special molar tube
Lack of adaptability to correct class III
conditions
Limitation to maximal opening
Potential injury to the patient if breakage
occurs and the rigid molar attachment
forces the broken portion into the soft
tissues.


Forsus Fatigue resistant
Device

This is an interarch push
spring which produces
about 200g of force when
fully compressed.

The distal end of the
FRD`s push rod inserts
into the telescopic cylinder
and a hook on the mesial
end is crimped directly to
the archwire near the
canine or premolar
brackets.

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

Advantages:
It does not require time-consuming and
expensive lab work or the use of stainless
steel crowns.
It produces consistent treatment results in a
predictable amount of time, without
depending on
patient cooperation.
It can deliver an orthopedic effect to both
jaws or more of a dentoalveolar effect.
It can be activated more on one side than on
the other, so it excels at correcting midline
deviations.

Heinig N, Goz G 2001 reported the use of
`

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

The occlusal plane was rotated by 4.2 degrees in
clockwise direction as a result of intruding the lower
incisors and the upper molars. The maxillary and
mandibular arches were expanded at the front and
rear during treatment. Evaluation of a questionnaire
filled in by the patients after 2 months of treatment
showed that approximately half of them had
experienced difficulties in brushing their teeth.
The main problem, however, was the restriction
experienced in the ability to yawn. Overall, two
thirds of the adolescents found the Forsus spring
better than the appliance previously used to correct
their Class II malocclusion, such as headgear,
activator or Class II elastics.
CONCLUSION: The Forsus spring has stood the test
in clinical application. It is a good supplement to the
Class II appliance systems already available.

William Wogt JCO June 2006 reports a case
where a 12 year old male with class II division
1 and moderate overjet of 7mm was
corrected with the Fatigue resistant device in
6months after which it was used as an
anchorage unit for the retraction of the
maxillary anterior segment.


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


References:
1.

Larry.W. White :Current Herbst Appliance
Therapy:JCO 1997,May(296 - 309)

2.

Arji George, V. Surendra Shetty, SN Rao &
Ashima Valiathan: Effect of Herbst appliance
on Orofacial musclature. Journal of Indian
Orthodontic Society. 1993; 4(3): 93-99.

3. S.Jay Bowman: Jasper Jumper in Class II
correction. A case report. JIOS 2001;34:101105.

4.

5.

Kinzinger, Oestheimer, Deidrich:
Development of a new fixed functional
appliance for treatment of skeletal class II
malocclusion.J. Orofac Orthop 2002
63:384-399
Ken Hansen: Treatment and posttreatment
effects of the herbst appliance on the dental
arches and arch relationships. Semin
Orthod 2003 March,page 67-73


6. Kinzinger, Deidrich: Bite jumping with the

functional mandibular Advancer, JCO
December 2005 page 696-700

7. Carlos Martins Coelho Filho,Mandibular

Protraction Appliances for Class II Treatment
Volume 1995 May(319 - 336)

8. Klapper L, The Super spring II: A new

appliance for non-compliant class II patients.
J. Clin. Orthod. 1999; 33: 50-54.


9. Sabine Ruf, Hans Pancherz: When is the ideal period

for Herbst therapy-Early or Late? Semin Orthod
2003,March,page 47-56

10. Mc Namara, Brudon, Kokich, Orthodontics and

Dentofacial Orthopaedics, 2001 page 285,333

11. Cope J.B., Buschang P., Cope D.D., Parker J.,

Blackwood H.O. Quantitative evolution of craniofacial
changes with Jasper Jumper Therapy. Angle Othod.
1994; 64 (2): 113 – 122.


12. Miller R.A. The Flip-lock Herbst Appliance.

J. Clin. Orthod. 1996; 30: 552 – 58.

13. Jasper J.J., McNamara J. The correction of

interarch malocclusions using a fixed force
module. Am. J. Orthod. Dentofac. Orthop.
1995; 108: 641-50.

14. Pancherz H. Treatment of Class II

malocclusions by jumping the bite with the
Herbst appliance. A cephalometric
investigation. Am. J. Orthod. 1979; 76:
423-442

15. Heinig N, Goz G: Clinical application and

effects of the Forsus spring. A study of a new
Herbst hybrid, J Orofac Orthop. 2001
Nov;62(6):436-50.
16. Pancherz H. The mechanism of Class II

correction in Herbst appliance treatment. Am.
J. Orthod. 1982; 87: 1-20.
17. Pancherz H. The Herbst appliance – Its

biological effects and clinical use. Am. J.
Orthod. 1985; 87: 1-20.


18. Erdogan E. Asymmetric Application of the

Jasper Jumper in the correction of midline
discrepancies. J. Clin. Orthod. 1998; 32:
170 – 80.
19. Sabine Ruf:Short and Longterm effects of
onTemporomandibular joint
function,Semin Orthod 2003 March page
74-86.
20. Cash R.G. Case Report: adult
nonextraction treatment with a Jasper
Jumper. J. Clin. Orthod. 1991; 25: 43-7..

21. Castañon R., Valdes M., White L.W.

Clinical use of the Churro Jumper. J.
Clin. Orthod. 1998; 32: 731 – 45.
22. Blackwood H.O. Clinical Management

with the Jasper Jumper. J. Clin.
Orthod. 1991; 25: 755-60
23. Haegglund P. The Swedish-Style
Integrated Herbst Appliance. J. Clin.
Orthod. 1997; 31: 378 – 390.

24. Pangrazio-Kulbersh V, Berger JL, Chermak

DS, Kaczynski R, Simon ES, Haerian
A:Treatment effects of the mandibular
anterior repositioning appliance on patients
with Class II malocclusion. Am J Orthod
Dentofacial Orthop. 2003 Mar;123(3):286-95
25.

Calvez X. The universal bite jumper. J.
Clinical Orthod. 1998; 32: 493-499.

26. Filho C.M. Mandibular Protraction Appliances

for Class II Treatment. J. Clin. Orthod. 1995;
29: 319 – 336.

27. Hans Pancherz :History, Background, and

Development of the Herbst Appliance, Semin
Orthod 2003,March page3-11
28. Filho C.M. Clinical Applications of the

Mandibular Protraction Appliance. J. Clin.
Orthod. 1997; 31: 92 – 102.
29. Filho C.M. The Mandibular Protraction

Appliance III. J. Clin. Orthod. 1998; 32: 379384


30. Mandeep sood, k.Sadashiva Shetty:

Functional therapy- Is it worth the effort?
JIOS1994 October page 128-136.

31. Aidar LA, Abrahao M,Yamashita HK,

Dominguez GC:Herbst appliance therapy
and temporomandibular joint disc position- A
prospective longitudinal magnetic resonance
imaging study. Am J Orthod Dentofacial
Orthop. 2006 Apr;129(4):486-96.

32. William Vogt:The Forsus Fatigue Resistant

Device, JCO 2006 June page 368-376


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