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FIXED FUNCTIONAL
APPLIANCES
CONTENTS
Classification
Based on mode of action
Classification by RITTO KORRODI (2001)
Based on type of force produced
INTRODUCTION
DEFINITION
DEFINITION
o an appliance that produces all or part of its effect by altering the position of the
mandible
X Very bulky,
X Have unbalanced fixation,
X Absence of tactile sensibility, comfort,
X Apply pressure on the mucosa (causing gingivitis),
X Cause problems in deglutition, speech
X Reduce space for the tongue & commonly affect facial appearance.
• Unfortunately due to the bulk and inconvenience, removable functional appliance fails to
• In addition, their intermittent wear does not elicit continuous muscle activity , a factor that
removable appliance wear will result in slow treatment response or no response at all.
• The bite plate was the forerunner of the modern functional appliances.
• Whereas Fixed functional appliances first appeared in 1910 when Emil Herbst presented
• Since then and up to the seventies, very little was published on this appliance.
• It was at that time that Hans Pancherz brought the subject back into the discussion with
Functional appliance
Reduction of local regulators (factors having –ve feedback effects on cell multiplication rate)
Legnthening of mandible
MODE OF ACTION
INDICATIONS
• Jasper jumper
• Herbst , its
• Adustable bite
modifications
corrector
• Jasper jumper
• Churro jumper • SAIF Appliance (Severable
• Eureka spring
• Amoric torsion Adjustable intermaxillary
• Adjustable bite
coils Force Spring )
corrector
• Klapper super
• Forsus
spring
• MPA (I, II, III, IV)
• Bite fixer (ormco)
• MARA
• Flex developer
RIGID FIXED FUNCTIONAL
APPLIANCES
Herbst Appliance
( EMIL HERBST) – 1910
• Herbst presented his appliance for the first time at the 5th international Dental Congress
in Berlin in 1909.
• Pancherz, Hagg, (1985) Most favorable time - peak of pubertal growth spurt.
• Pancherz & Hagg (1988) Indicated that the patients treated at the initial closure of the
middle phalanx of the third finger (MP3FG) had the greatest amount of condylar growth
• Ruf, Pancherz (March 2003) permanent dentition or just after the pubertal peak of growth
corresponding to the skeletal maturity stages FG to H of the middle phalanx (implying the
precapping to preunion stages of epiphysis and diaphysis)
• Perfect end result cannot be obtained exclusively with Herbst.
• Class II cases cannot be treated to a perfect end result with the Herbst appliance
exclusively.
Most suitable in the treatment of Class II malocclusions with a retrognathic mandible and
Maxillary and mandibular teeth should be well aligned and the dental arches should fit each
The increase in mandibular length - due to condylar growth stimulation as an adaptive reaction
the gonion angle increased slightly. (This may be due to a more sagittally directed growth of
the condyle or it may result from resorptive bone changes in the gonion region, probably as a
When jumping the bite, occlusal contacts existed only between the incisors while the buccal
Thus, vertical tooth eruption and growth in the posterior segments were allowed to take place
freely.
This accounted for the reduction of overbite and the increase in lower facial height found in
the patients
HERBST VS ACTIVATOR
• Functional therapy with activators is often used to influence mandibular growth. However,
it has not yet been shown that treatment has any significant effect on condylar growth.
• This can be explained by the fact that the activator is used only 10 to 12 hours a day.
Because of this, the threshold for adaptive remodeling processes in the condyle will not be
attained.
• When the Herbst appliance is used, on the other hand, the mandible is continuously held in
an anterior jumped position 24 hours a day
Treatment results using herbst appliance :
1. Normal occlusal conditions occurred in all patients.
2. Maxillary growth may have been inhibited or redirected. The SNA angle was reduced slightly.
3. Mandibular growth was greater than average. The SNB angle increased.
5. Lower facial height increased. The mandibular plane angle, however, remained unchanged.
6. The convexity of the soft- and hard-tissue profile was somewhat reduced.
Herbst problems
children. As it attached
Advantages
Instead of PM1 band – entire mand.
Dentition, thereforpts at any stage of dental
development can be fitted with herbst
Intrusion of lower premolar avoided as
whole dentition is used as segment
Prevents mesial migration of incisors
Tissue impingement avoided as there is no
lingual wire
Failure due to breakage of band is
eliminated
Edgewise Bioprogressive Herbst
appliance
(TERRY G. DISCHINGER)
1989
model
Reactivation - 2mm every six
weeks.
Average treatment time was six
months,
Mean overjet reduction was
5.2mm
Mean molar correction was
6.5mm
FLIP-LOCK HERBST APPLIANCE
FLIP LOCK
(ROBERT A MILLER)
1996
Advantages :
Less irritation
reduces the number of moving parts that
can lead to breakage or failure
Mand Protraction App
(carlos martins coelho)
1991,1998,2001
They are easily fabricated at chairside with ordinary, inexpensive wires.
Do not require any special bands, crowns, or wire attachments.
No impressions or wax bite registrations are used, and no laboratory
assistance is needed.
Easily inserted, adjusted, and removed.
Can be made and installed in about 30 minutes.
They are much smaller and thus more comfortable and acceptable to patients
than other appliances.
They permit a greater range of motion and are less restrictive of movement
than other
MPA 1
MPA 1I
MPA III
• Two maxillary tubes of .045" internal diameter, each about 27mm
long
• Two maxillary loops of .040" stainless steel wire, each about 13mm
long, with a loop bent into one end at an angle of about 130° to the
horizontal
• Two mandibular rods of .036" stainless steel wire, each about 27mm
long
• Four pieces of band material
• Two short lengths of annealed .036" stainless steel wire, each with a
loop in one end, for attaching the appliance to the maxillary molar
headgear tube
MPA III
MPA IV
“T”
“ tube ; Upper molar locking pin ; Mandibular rod ; Mandibular
archwire
The amount of activation will be determined by the number of turns in the coil
The Mandibular Protraction Appliance has proven to be effective
during approximately 10 years of clinical use.
This fourth version seems to be as efficient as its antecedents, but is
much more practical to construct,
easy to manipulate, and
comfortable for the patient
IST (INTRA ORAL
SNORING THERAPY) APP
(Hinz germany)
disengaging.
• The appliance is available in two more lengths..
MARS APPLIANCE
(Ralph Clements and Alex Jacobson)
- 1982
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.
RITTO APPLAINCE
(RITTO A. K- 1998)
• The two rods are connected by a rigid shaft and have pivotal region at their ends.
• Esthetic acceptability to patients. Eureka Spring, is almost invisible because of its small size
and lack of protuberances into the buccal vestibule.
• Resistance to breakage. Sentalloy and Saif springs break far too often; breakage of elastics discourages patient cooperation
and probably prolongs treatment time.
• Forces in the range of 220-280g can be measured at the points of attachment in closure of the Jasper Jumper or in wide
opening of the Saif Spring.
• The Eureka Spring produces forces of only 140-170g at the points of attachment, reducing the possibility of breakage.
• It never functions in any mode other than straight compression, which is evenly distributed over the entire length of the
spring.
• Wave motion normally would develop within the spring as compression increases, but is prevented by the guiding shaft on
the inside and the cylinder on the outside. These factors, along with the use of low-fatigue material, have produced a spring
life of three to six months
• Eureka Spring continues to work even when the mouth is opened as much as 20mm, as
when sleeping, or when the mandible is thrust forward as far as 10mm in an attempt to
• The Jasper Jumper applies no force in these two positions. In addition, frequent breakage
of the Jasper Jumper and Saif Spring result in a wide range of correction rates.
Forsus : Fatigue resistant
Device
(William vogt – 2006 3M UNITEK)
• 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
• 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
• CONCLUSION: The Forsus spring has stood the test in clinical application. It is a good
• 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.
• 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.
Attachment to the main arch wire
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.
X If an arch breaks or comes untied at the distal tieback, all the force is
transferred to the anterior teeth, which tends to tip them forward depress
them and open space.
• 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.
• 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.
• 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.
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