Fixed functional appliance

FIXED FUNCTIONALFIXED FUNCTIONAL
APPLIANCESAPPLIANCES
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INTRODUCTIONINTRODUCTION
 Successful orthodontic treatment often reliesSuccessful orthodontic treatment often relies
on patient co-operation in wearing ofon patient co-operation in wearing of
elastics,headgears or removable appliances.elastics,headgears or removable appliances.
 Compliance of patients is reduced and greaterCompliance of patients is reduced and greater
control in treatment established with fixedcontrol in treatment established with fixed
functional appliances.functional appliances.
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CLASSIFICATIONCLASSIFICATION
 RIGID FIXED FUNCTIONALRIGID FIXED FUNCTIONAL
 HERBSTHERBST
 MANDIBULAR PROTRACTION APPLIANCEMANDIBULAR PROTRACTION APPLIANCE
 I,II,III,IVI,II,III,IV
 FORSUS NITINOL FLAT SPRINGFORSUS NITINOL FLAT SPRING
 EUREKA SPRINGEUREKA SPRING
 UNIVERSAL BITE JUMPERUNIVERSAL BITE JUMPER
 TWIN FORCE BITE CORRECTORTWIN FORCE BITE CORRECTOR

CLASSIFICATIONCLASSIFICATION
 NON-RIGID FIXED FUNCTIONALNON-RIGID FIXED FUNCTIONAL
APPLIANCESAPPLIANCES
 JASPER JUMPERJASPER JUMPER
 ADJUSTABLE BITE CORRECTOR(ABC)ADJUSTABLE BITE CORRECTOR(ABC)
 CHURRO JUMPERCHURRO JUMPER

INDICATIONSINDICATIONS
 POST ADOLESCENT PATIENTSPOST ADOLESCENT PATIENTS
 MOUTH BREATHERSMOUTH BREATHERS
 UNCO-OPERATIVE PATIENTSUNCO-OPERATIVE PATIENTS
 PATIENTS WHO DO NOT RESPOND TOPATIENTS WHO DO NOT RESPOND TO
REMOVABLE FUNCTIONAL THERAPYREMOVABLE FUNCTIONAL THERAPY
 MULTIPHASE TREATMENT APPROACHMULTIPHASE TREATMENT APPROACH

UNDESIRABLE DENTALUNDESIRABLE DENTAL
CHANCESCHANCES
 Labial tipping or flaring of lower incisorLabial tipping or flaring of lower incisor
 Maxillary posterior dental expansion &Maxillary posterior dental expansion &
intrusion of buccal cusps(lingual root torqueintrusion of buccal cusps(lingual root torque
effect.effect.
 Anterior movement of lower dentoalveolarAnterior movement of lower dentoalveolar
process beyond that of the body of theprocess beyond that of the body of the
mandible or apical base.mandible or apical base.
 Lingual tipping of maxillary incisor.Lingual tipping of maxillary incisor.

WAYS TO COUNTERACTWAYS TO COUNTERACT
 Full sized rectangular arch wire with 10 to 15 degreeFull sized rectangular arch wire with 10 to 15 degree
lingual crown torque placed in the lower incisorlingual crown torque placed in the lower incisor
region.region.
 Transpalatal arch & lingual stabilizing arch toTranspalatal arch & lingual stabilizing arch to
enchance anchorage. Buccal root torque on TPA willenchance anchorage. Buccal root torque on TPA will
counteract with intrution of buccal cusps.counteract with intrution of buccal cusps.
 Lingual tipping of maxillary incisor over come byLingual tipping of maxillary incisor over come by
lingual root torque of incisor region or pretorquedlingual root torque of incisor region or pretorqued
bracket with full sized arch wire tied back.bracket with full sized arch wire tied back.

PATIENT EDUCATIONPATIENT EDUCATION
 A patient who resists the forward push of theA patient who resists the forward push of the
fixed functional appliance by forciblyfixed functional appliance by forcibly
retruding the mandible will cause moreretruding the mandible will cause more
forward movement of teeth and dentoalveolarforward movement of teeth and dentoalveolar
process.process.
 Patient is asked to relax the jaw in aPatient is asked to relax the jaw in a
comfortable position.comfortable position.
 Proper patient education is vital for successfulProper patient education is vital for successful
fixed functional therapy.fixed functional therapy.

H/O FIXED FUNCTIONAL APPLIANCESH/O FIXED FUNCTIONAL APPLIANCES
 At the 5 INTERNATIONAL DENTAL CONGRESS inAt the 5 INTERNATIONAL DENTAL CONGRESS in
BERLIN(1909) EMIL HERBST(1872-1940)BERLIN(1909) EMIL HERBST(1872-1940)
presented a fixed bite jumping device calledpresented a fixed bite jumping device called
OKKLUSIONSSCHARNIER orOKKLUSIONSSCHARNIER or
RETENTIONSSCHARNIER.RETENTIONSSCHARNIER.
 He published 3 articles regarding this inHe published 3 articles regarding this in
“ZAHNARZTLICHE RUNDCHAU”“ZAHNARZTLICHE RUNDCHAU”
 MARTIN SCHWARZ published more or less criticalMARTIN SCHWARZ published more or less critical
articles about HERBST.His concern was the overload toarticles about HERBST.His concern was the overload to
the anchorage teeth with periodontal damage as athe anchorage teeth with periodontal damage as a
consequence.consequence.
 PIETZ disprooved this after which it was FORGOTTEN.PIETZ disprooved this after which it was FORGOTTEN.
 HANS PANCHERZ (1970) revived the whole appliance.HANS PANCHERZ (1970) revived the whole appliance.

FEDERGELENKFEDERGELENK
 This appliance was designed by FRANKEL.This appliance was designed by FRANKEL.
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HERBST APPLIANCE DESIGNHERBST APPLIANCE DESIGN
 Each telescopic deviceEach telescopic device
consists of a tube,aconsists of a tube,a
plunger,two pivots and twoplunger,two pivots and two
locking screws to preventlocking screws to prevent
the telescoping parts fromthe telescoping parts from
slipping past the pivots.slipping past the pivots.
 The pivot for the tubeThe pivot for the tube
soldered to the maxillarysoldered to the maxillary
first molar band& plungerfirst molar band& plunger
pivot affixed to mandibularpivot affixed to mandibular
first premolar band.first premolar band.

 The length of the tubeThe length of the tube
determines the amountdetermines the amount
of bite jumping.of bite jumping.
 The mandible usuallyThe mandible usually
retained in incisal end toretained in incisal end to
end relation.end relation.
 A large interpivotA large interpivot
distance prevents thedistance prevents the
plunger from slippingplunger from slipping
out of the tube when theout of the tube when the
mouth is wide open.mouth is wide open.

 Upper pivot placedUpper pivot placed
distally on the molardistally on the molar
band and the lowerband and the lower
pivot placed mesiallypivot placed mesially
on the premolar band.on the premolar band.
 AnchorageAnchorage
considerations-halfconsiderations-half
round 1.5x0.75mm orround 1.5x0.75mm or
1mm buccal or lingual1mm buccal or lingual
sectional arch wire.sectional arch wire.

 BRADLEY(JO2000)BRADLEY(JO2000)
 DENTAL CLASS II MALOCCLUSIONDENTAL CLASS II MALOCCLUSION
 SKELETAL CLASS II MANDIBULARSKELETAL CLASS II MANDIBULAR
DEFICIENCY.DEFICIENCY.
 DEEP BITE WITH RETROCLINEDDEEP BITE WITH RETROCLINED
MANDIBULAR INCISORS.MANDIBULAR INCISORS.

CONTRAINDICATIONSCONTRAINDICATIONS
 BRADLEY&MCSCHERRY(JO2000)BRADLEY&MCSCHERRY(JO2000)
 ROOT RESORPTION.ROOT RESORPTION.
 DENTAL & SKELETAL OPEN BITES.DENTAL & SKELETAL OPEN BITES.
 VERTICAL GROWTH WITH HIGHVERTICAL GROWTH WITH HIGH
MAXILLOMANDIBULAR PLANE ANGLEMAXILLOMANDIBULAR PLANE ANGLE
 EXCESSIVE LOWER ANTERIOR FACIALEXCESSIVE LOWER ANTERIOR FACIAL
HEIGHT.HEIGHT.

SAGITTAL CHANGESSAGITTAL CHANGES
 HAGG&PANCHERZ(1988)HAGG&PANCHERZ(1988)
 Restrains maxillary growth and stimulatesRestrains maxillary growth and stimulates
mandibular growth.mandibular growth.
 PANCHERZ&LITTMANN(1988)PANCHERZ&LITTMANN(1988)
 Sagittal condylar growth increases & verticalSagittal condylar growth increases & vertical
condylar growth unaffected.condylar growth unaffected.
 Bone remodelling process in the lower border ofBone remodelling process in the lower border of
the mandible changes the morphology.the mandible changes the morphology.
 PANCHERZ&STICKEL(1989)PANCHERZ&STICKEL(1989)
 Ultimate condylar position unaffected byUltimate condylar position unaffected by
treatment.treatment.

 PANCHERZ(1979)PANCHERZ(1979)
 Articular fossa repositioned anteriorly in the skull.Articular fossa repositioned anteriorly in the skull.
 Saggital molar correction 43% due to skeletalSaggital molar correction 43% due to skeletal
changes &57% due to dentoalveolar changes.changes &57% due to dentoalveolar changes.
 PANCHERZ&HANSEN(1986)PANCHERZ&HANSEN(1986)
 Mandibular teeth move anteriorly & lower incisorsMandibular teeth move anteriorly & lower incisors
procline.procline.
 Distalisation & intrusion of maxillary molars.Distalisation & intrusion of maxillary molars.
 McNamara(2000)McNamara(2000)
 Mean overjet decreased by 5.1mmMean overjet decreased by 5.1mm
 ANB angle decreased by 1.5degrees.ANB angle decreased by 1.5degrees.
 Maxillary incisors tipped lingually by 4.5degrees.Maxillary incisors tipped lingually by 4.5degrees.
 Mandibular incisors proclined by 2.9degreesMandibular incisors proclined by 2.9degrees

 McNamara&Brudon(1993)McNamara&Brudon(1993)
 Rebound effect of lower incisors retroclining afterRebound effect of lower incisors retroclining after
treatment.treatment.
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Vertical changesVertical changes
 Overbite reduced.Overbite reduced.
 Intrusion of lower incisorsIntrusion of lower incisors
 Enhansed eruption of lower molars.Enhansed eruption of lower molars.
 Maxillary&mandibular occlusal planes tip down.Maxillary&mandibular occlusal planes tip down.
 McNamara(2000)McNamara(2000)
 Mean overbite reduced by 2.3mm.Mean overbite reduced by 2.3mm.

TMJ CHANGESTMJ CHANGES
 Lateral movement capacity of mandible reduced byLateral movement capacity of mandible reduced by
average 1.9mm but returned to pretreatment values 1yearaverage 1.9mm but returned to pretreatment values 1year
post-treatment.post-treatment.
 Joint Tenderness-Joint Tenderness-
Increased 20-45%during first 3 months of treatment.Increased 20-45%during first 3 months of treatment.
Reduced 15% after treatmentReduced 15% after treatment
Reduced 10% 1 year after treatmentReduced 10% 1 year after treatment
 HANSEN(1990)HANSEN(1990)
 TMJ sounds-26%TMJ sounds-26%
 Muscle tenderness-32%Muscle tenderness-32%
 8% of condyles posteriorly displaced.8% of condyles posteriorly displaced.
 Condyles slightly anteriorly positioned in fossa.Condyles slightly anteriorly positioned in fossa.

 Before treatment the disc was in slightly protrusiveBefore treatment the disc was in slightly protrusive
position relative to condyle.position relative to condyle.
 During treatment the disc attained pronouncedDuring treatment the disc attained pronounced
retrusive position due to relative movement ofretrusive position due to relative movement of
disc&condyle on mandibular protrusion.disc&condyle on mandibular protrusion.
 Post-treatment condylar position unchanged.Post-treatment condylar position unchanged.
 The disc in slightly retrusive position.The disc in slightly retrusive position.
 RUFF&PANCHERZ(2000)RUFF&PANCHERZ(2000)
 During treatment the condylar position movedDuring treatment the condylar position moved
forward but returned to original positionforward but returned to original position
posttreatment.posttreatment.
 Temporary capsulitis of the inferior stratus ofTemporary capsulitis of the inferior stratus of
posterior attachment was induced during treatment.posterior attachment was induced during treatment.

JASPER JUMPERJASPER JUMPER
 Dr.James JasperDr.James Jasper
designed this appliance.designed this appliance.
 Modification of herbstModification of herbst
bite jumpingbite jumping
mechanism.mechanism.
 Interarch flexible forceInterarch flexible force
module allows greatermodule allows greater
freedom of mandibularfreedom of mandibular
movement. Consists ofmovement. Consists of
two componentstwo components
 Force moduleForce module
 Anchor unitAnchor unit
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FORCE MODULEFORCE MODULE
 Consists of stainless steelConsists of stainless steel
coil or spring attached atcoil or spring attached at
both ends to stainless steelboth ends to stainless steel
end cabs in which holesend cabs in which holes
have been drilled in thehave been drilled in the
flanges to accommodateflanges to accommodate
the anchoring unit.the anchoring unit.
 Module is surrounded byModule is surrounded by
an opaque polyurethanean opaque polyurethane
covering for hygiene andcovering for hygiene and
comfortcomfort
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 Available in 7 lengths ranging from 26 to 38Available in 7 lengths ranging from 26 to 38
mm in 2mm increments.mm in 2mm increments.
 1 to 16 ounces of force produced.1 to 16 ounces of force produced.
 When the force module is straight it remainsWhen the force module is straight it remains
passive as the teeth come in occlusion thepassive as the teeth come in occlusion the
spring of the force module is curved axiallyspring of the force module is curved axially
converting the kinetic energy captured toconverting the kinetic energy captured to
potential energy.potential energy.
 The spring mechanism is activated 4mm toThe spring mechanism is activated 4mm to
resting length storing 8 ounces of potentialresting length storing 8 ounces of potential
energy.energy.
 Increasing activation beyond 4mm buildsIncreasing activation beyond 4mm builds
excessive internal stress.excessive internal stress.www.indiandentalacademy.comwww.indiandentalacademy.com

 Attached posteriorly to the maxillaryAttached posteriorly to the maxillary
arch by a ball pin placed through thearch by a ball pin placed through the
distal attachment of the forcedistal attachment of the force
module,the module extendsmodule,the module extends
anteriorly through the face bow tubeanteriorly through the face bow tube
on the upper first molar band.on the upper first molar band.
 The ball pin is anchored in positionThe ball pin is anchored in position
by a return bend placed at its mesialby a return bend placed at its mesial
end.end.
 Bayonet bend are placed distal toBayonet bend are placed distal to
mandibular canine and lexan beadsmandibular canine and lexan beads
provide anterior stop.provide anterior stop.
 The removal of 1 & 2 premolarThe removal of 1 & 2 premolar
brackets allow greater freedom ofbrackets allow greater freedom of
movements.movements.
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 Use of OUTRIGGERS (BLACKWOOD 1991)Use of OUTRIGGERS (BLACKWOOD 1991)
 .016 x .022 inch (.018 inch slot) or .018 x .025.016 x .022 inch (.018 inch slot) or .018 x .025
inch (.022 inch slot) auxillary sectional wireinch (.022 inch slot) auxillary sectional wire
anchored anteriorly to main arch wire betweenanchored anteriorly to main arch wire between
1st premolar & canine.1st premolar & canine.

CLINICAL MANAGEMENTCLINICAL MANAGEMENT
 ANCHORAGEANCHORAGE
 Full sized arch wire with cinchback posteriorlyFull sized arch wire with cinchback posteriorly
&lower anterior lingual crown torque&lower anterior lingual crown torque
 Posterior tip back bend.Posterior tip back bend.
 Lower incisor bracket with 5 degree lingual crown torque.Lower incisor bracket with 5 degree lingual crown torque.
 Transpalatal arch &lingual stabilising arch.Transpalatal arch &lingual stabilising arch.
 FORCE MODULE SELECTIONFORCE MODULE SELECTION
 distance from mesial of upper molar tube to distal of lowerdistance from mesial of upper molar tube to distal of lower
lexan bead +12mm.lexan bead +12mm.
 High angle -2mm deflection (150 gms).High angle -2mm deflection (150 gms).
 Normal, low angle- 4mm deflection (300 gms).Normal, low angle- 4mm deflection (300 gms).

TREATMENT EFFECTSTREATMENT EFFECTS
 Intrusion and distalisation of upper molarsIntrusion and distalisation of upper molars
with occasional opening of posterior bite.with occasional opening of posterior bite.
 Some indication of condylar growth.Some indication of condylar growth.
 Anterior migration of mandibular teethAnterior migration of mandibular teeth
through alveolar bone.through alveolar bone.
 Intrusion of lower incisors.Intrusion of lower incisors.
 Expansion of upper molars.Expansion of upper molars.

JASPERS THEORY OFJASPERS THEORY OF
TWO’S(1991)TWO’S(1991)
 Cl II correction with JJCl II correction with JJ
 20%-maxillary basal restraint.20%-maxillary basal restraint.
 20%-backward maxillary dentoalveolar movement.20%-backward maxillary dentoalveolar movement.
 20%-forward mandibular dentoalveolar movement.20%-forward mandibular dentoalveolar movement.
 20%-condylar growth stimulation.20%-condylar growth stimulation.
 20%-downward & forward glenoid fossa20%-downward & forward glenoid fossa
remodelling.remodelling.

 BRADLEY & MCSHERRY(JO 2000)BRADLEY & MCSHERRY(JO 2000)
 Dental class 2 malocclusionDental class 2 malocclusion
 Skeletal class 2 with maxillary excess as opposedSkeletal class 2 with maxillary excess as opposed
to mandibular deficiencyto mandibular deficiency
 Deepbite with retroclined mandibular incisorDeepbite with retroclined mandibular incisor
CONTRAINDICATIONSCONTRAINDICATIONS
 Root resorptionRoot resorption
 Dental&skeletal open bitesDental&skeletal open bites
 Vertical growth with high MPA and excessiveVertical growth with high MPA and excessive
lower facial height.lower facial height.

ADJUSTABLE BITEADJUSTABLE BITE
CORRECTORCORRECTOR
 RICHARD P. WESTRICHARD P. WEST
(JCO 1995)(JCO 1995)
 This strechable closedThis strechable closed
coil spring & internallycoil spring & internally
threaded end cap allowthreaded end cap allow
parts to rotate freelyparts to rotate freely
like a nut on a bolt.like a nut on a bolt.
 The axial or push forceThe axial or push force
generated by NiTi wiregenerated by NiTi wire
in center lumen.in center lumen.
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ADJUSTABLE BITEADJUSTABLE BITE
CORRECTORCORRECTOR
 Used on either side of the mouth with a simple 180 degreeUsed on either side of the mouth with a simple 180 degree
rotation of the lower end cap to change its orientation.rotation of the lower end cap to change its orientation.
 ABC opened up 1 half turn prior to placement to swivelABC opened up 1 half turn prior to placement to swivel
from occlusion duringfrom occlusion during

EUREKA SPRINGEUREKA SPRING
 JOHN DEVINCENZO(JCOJOHN DEVINCENZO(JCO
1997)1997)
Devised by NORTHCUT inDevised by NORTHCUT in
1974.1974.
This consists of open woundThis consists of open wound
coil spring in triple telescopingcoil spring in triple telescoping
plunger assembly.plunger assembly.
The spring rests in the buccalThe spring rests in the buccal
sulcus & attached posteriorly tosulcus & attached posteriorly to
headgear tubes on the upper 1stheadgear tubes on the upper 1st
molar & anteriorly to lower archmolar & anteriorly to lower arch
wire distal to cuspidwire distal to cuspid
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EUREKA SPRINGEUREKA SPRING
 A triple telescoping action allows 60mm ofA triple telescoping action allows 60mm of
mouth opening before disengaging.mouth opening before disengaging.
 16gm force exerted for every mm RAM16gm force exerted for every mm RAM
compression.compression.
 TPA is a must.TPA is a must.
 Only dentoalveolar effect,no orthopaedicOnly dentoalveolar effect,no orthopaedic
effect.effect.

 INDICATIONSINDICATIONS
 Dental class 2 malocclusion .Dental class 2 malocclusion .
 Deep bite with retroclined mandibular incisor.Deep bite with retroclined mandibular incisor.
 CONTRA INDICATIONSCONTRA INDICATIONS
 Class 3 with anterior open bite.Class 3 with anterior open bite.
 Procumbant lower incisor.Procumbant lower incisor.
 Deep buccal over bite or posterior cross bite.Deep buccal over bite or posterior cross bite.
 Extremly tight buccal musculature.Extremly tight buccal musculature.
 Minimal buccal vestibular space.Minimal buccal vestibular space.

SAIF springsSAIF springs
 Nickel titanium closed coil springs apply cl IINickel titanium closed coil springs apply cl II
intermaxillary traction.intermaxillary traction.
 Springs tied in place are used instead ofSprings tied in place are used instead of
intermaxiilary elastics.intermaxiilary elastics.
 Available in 2 lengthsAvailable in 2 lengths
 7mm7mm
 10mm10mm
 Prerequisites of successful treatmentPrerequisites of successful treatment
 Prior correction of deep bitesPrior correction of deep bites
 Rectangular arch wire.Rectangular arch wire.
 Direction of force as horizontal as possible.Direction of force as horizontal as possible.

MANDIBULAR ANTERIORMANDIBULAR ANTERIOR
REPOSITIONING APPLIANCE(MARA)REPOSITIONING APPLIANCE(MARA)
 This has cams madeThis has cams made
from .060 square wirefrom .060 square wire
attached to tubes onattached to tubes on
upper first molarupper first molar
bands or stainless steelbands or stainless steel
crowns.crowns.
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REPOSITIONING APPLIANCE(MARA)REPOSITIONING APPLIANCE(MARA)
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The lower molar has .The lower molar has .
059 arm projecting059 arm projecting
perpendicular to itsperpendicular to its
buccal surface engagesbuccal surface engages
the cam of the upperthe cam of the upper
molar.molar.
The cams guide theThe cams guide the
lower first molar andlower first molar and
repositions therepositions the
mandible anteriorly.mandible anteriorly.

TREATMENT EFFECTS OF MARATREATMENT EFFECTS OF MARA
 VALMY PANGRAZIO(AJO2003)VALMY PANGRAZIO(AJO2003)
 SKELETAL CHANGE-47%SKELETAL CHANGE-47%
 Increase in mandibular lengthIncrease in mandibular length
 Increase in anterior & posterior facial heightIncrease in anterior & posterior facial height
 DENTAL CHANGE-53%DENTAL CHANGE-53%
 Distalization of maxillary molar.Distalization of maxillary molar.
 Mandibular molar moved forward .7mmMandibular molar moved forward .7mm
 Mandibular incisors proclined and moved forward.Mandibular incisors proclined and moved forward.

MANDIBULAR PROTRACTIONMANDIBULAR PROTRACTION
APPLIANCE(MPA)APPLIANCE(MPA)
 CARLOS M.COELHOCARLOS M.COELHO
(1995) designed this(1995) designed this
appliance.appliance.
 He has made MPA I,II,III,IV.He has made MPA I,II,III,IV.
 MPA IV is the recentMPA IV is the recent
advancement.(JCO2004)advancement.(JCO2004)
 Made ofMade of
 T-tubeT-tube
 Upper molar locking pinUpper molar locking pin
 Mandibular rodMandibular rod
 Mandibular archwire.Mandibular archwire.
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MPA IVMPA IV

TREATMENT EFFECTSTREATMENT EFFECTS
 Increase in mandibular lengthIncrease in mandibular length
 Proclination of lower anteriorsProclination of lower anteriors
 Retroclination of upper anteriorsRetroclination of upper anteriors
 Forward positioning of the glenoid fossa.Forward positioning of the glenoid fossa.

FORSUS NITINOL FLAT SPRINGFORSUS NITINOL FLAT SPRING
 The flat nickel titaniumThe flat nickel titanium
spring attaches tospring attaches to
maxillary molar bandsmaxillary molar bands
with an attached pin andwith an attached pin and
loop assembly that slidesloop assembly that slides
into the headgear tubeinto the headgear tube
from the distal andfrom the distal and
cinched on the mesial.cinched on the mesial.
 Link n loopLink n loop
 Prevents the pin fromPrevents the pin from
being dropped duringbeing dropped during
insertion.insertion.
 Allows the patient toAllows the patient to
open wider.open wider.

 Other end connectedOther end connected
to mandibular mainto mandibular main
archwire or auxillaryarchwire or auxillary
bypass archwire.bypass archwire.
 A bayonet bendA bayonet bend
placed distal toplaced distal to
canines to act ascanines to act as
forward stop.forward stop.
 1&2premolar brackets1&2premolar brackets
removed to allowremoved to allow
greater range of actiongreater range of action
of spring.of spring.

 Maxillary archwire should not be cinched orMaxillary archwire should not be cinched or
tiedback unless maximum effect needed.tiedback unless maximum effect needed.
 Delivers 225-250grams of force whenDelivers 225-250grams of force when
compressed 5mm of initial activation.compressed 5mm of initial activation.
 A crimpable stop on archwire in front ofA crimpable stop on archwire in front of
spring provides 1.5mm of compression.spring provides 1.5mm of compression.

Klapper SUPERspringKlapper SUPERspring
 Auxillary fitted to fully banded upper and lower fixedAuxillary fitted to fully banded upper and lower fixed
appliance.appliance.
 Consists bilaterally a length of multiflex nickelConsists bilaterally a length of multiflex nickel
titanium.titanium.
 Attach to upper first molar tube &to lower archwireAttach to upper first molar tube &to lower archwire
by helical loop.by helical loop.
 Spring lies in the buccal vestibule.Spring lies in the buccal vestibule.
 Available-27mm-extraction case,40mm non-Available-27mm-extraction case,40mm non-
extraction cases.extraction cases.
 Special oval tube required to be fitted to upper firstSpecial oval tube required to be fitted to upper first
molars.molars.

 INDICATIONSINDICATIONS
 DENTAL CLASS II MALOCCLUSIONDENTAL CLASS II MALOCCLUSION
 DEEP BITE WITH RETROCLINED LOWERDEEP BITE WITH RETROCLINED LOWER
INCISORS.INCISORS.
 CONTRAINDICATIONSCONTRAINDICATIONS
 ROOT RESORPTIONROOT RESORPTION
 DENTAL & SKELETAL OPEN BITE.DENTAL & SKELETAL OPEN BITE.
 VERTICAL GROWTH WITH INCREASEDVERTICAL GROWTH WITH INCREASED
FMA AND LOWER FACIAL HEIGHT.FMA AND LOWER FACIAL HEIGHT.
 MINIMUM BUCCAL VESTIBULAR SPACE.MINIMUM BUCCAL VESTIBULAR SPACE.

TWIN FORCE BITE CORRECTORTWIN FORCE BITE CORRECTOR
 A fixed push typeA fixed push type
intermaxillary functionalintermaxillary functional
appliance with ball andappliance with ball and
socket joint fasteners.socket joint fasteners.
 Two plunger/tubeTwo plunger/tube
telescopic assembliestelescopic assemblies
contain niti coil springs.contain niti coil springs.
 210grams of force on210grams of force on
full compression.full compression.
 Hex nuts fastened toHex nuts fastened to
mesial end of maxillarymesial end of maxillary
molars and distal ofmolars and distal of
mandibular canines.mandibular canines.
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APPLIANCE DESIGNAPPLIANCE DESIGN
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SIZE SELECTIONSIZE SELECTION
 2 sizes available2 sizes available
 #424-215Ti-STANDARD VERSION#424-215Ti-STANDARD VERSION
 #424-216Ti-SMALL VERSION#424-216Ti-SMALL VERSION
 To determine sizeTo determine size
 The distanse from the mesial end of upper molarThe distanse from the mesial end of upper molar
tube to distal edge of lower cuspid bracket.tube to distal edge of lower cuspid bracket.
 If measurement less than 27mm small versionIf measurement less than 27mm small version
needed.needed.
 If measurement greater than 27mm standardIf measurement greater than 27mm standard
version needed.version needed.

PRE-FUNCTIONALPRE-FUNCTIONAL
TREATMENTTREATMENT
 Align maxillary dentition to normal as itAlign maxillary dentition to normal as it
relates to the maxilla.relates to the maxilla.
 Align mandibular dentition to normal as itAlign mandibular dentition to normal as it
relates to the mandible.relates to the mandible.
 Lower arch should be flat,bite sufficientlyLower arch should be flat,bite sufficiently
open,with lower lingual arch.open,with lower lingual arch.

INSTALLATIONINSTALLATION
 STEP I:STEP I:
 PLACE LOWER FIXED LINGUAL ARCH.PLACE LOWER FIXED LINGUAL ARCH.
 PLACE LOWER RECTANGULAR ARCH WITHPLACE LOWER RECTANGULAR ARCH WITH
LINGUAL CROWN TORQUE OF LOWERLINGUAL CROWN TORQUE OF LOWER
INCISORS.(0.016X0.022 forINCISORS.(0.016X0.022 for
0.018SLOT,0.017X0.0225 for 0.022SLOT)0.018SLOT,0.017X0.0225 for 0.022SLOT)
 CINCH BACK ARCHWIRE OR E-CHAINCINCH BACK ARCHWIRE OR E-CHAIN
FROM MOLAR-MOLAR TO PREVENTFROM MOLAR-MOLAR TO PREVENT
SPACING IN THE ARCH.SPACING IN THE ARCH.
 TIE IN CUSPIDS WITH LIGATURE WIRETIE IN CUSPIDS WITH LIGATURE WIRE
TIES.TIES.

 STEP IISTEP II
 Band maxiilary molars with convertible buccalBand maxiilary molars with convertible buccal
tube.tube.
 Place lingual sheath for TPA.Place lingual sheath for TPA.
 Place rectangular wire with bite opening curve andPlace rectangular wire with bite opening curve and
molar expansion cinchback or powerchain.molar expansion cinchback or powerchain.
 Tie-in cuspids with wire ligature ties.Tie-in cuspids with wire ligature ties.

 STEP IIISTEP III
 Place archwire clamp mesial to facebow tube and tightenPlace archwire clamp mesial to facebow tube and tighten
screw.screw.
 Large size rectangular archwire used for stability.Large size rectangular archwire used for stability.
 STEP IVSTEP IV
 Place archwire clamp distal to lower cuspid bracket&Place archwire clamp distal to lower cuspid bracket&
tighten screw.tighten screw.
 STEP VSTEP V
 Check patient with patient mouth open and closed.Check patient with patient mouth open and closed.
 Check lateral movement.Check lateral movement.
 Soft diet for 1-3days initially.Soft diet for 1-3days initially.
 Acetaminophen or ibuprofen given for discomfort.Acetaminophen or ibuprofen given for discomfort.www.indiandentalacademy.comwww.indiandentalacademy.com

MAINTANENCEMAINTANENCE
 Patient recalled once a week then once everyPatient recalled once a week then once every
month.month.
 Avoid spacing as maxillary arch moves distalAvoid spacing as maxillary arch moves distal
and mandibular arch moves mesial.and mandibular arch moves mesial.
 1-2mm of movement every month observed.1-2mm of movement every month observed.
 Most correction is orthodontic usually 0-2mmMost correction is orthodontic usually 0-2mm
of orthopaedic changes.of orthopaedic changes.
 Figure 8 wire tie for maximum anchorage.Figure 8 wire tie for maximum anchorage.

UNIVERSAL BITE JUMPERUNIVERSAL BITE JUMPER
 Introduced by XAVIERIntroduced by XAVIER
CALVEZ (JCO1998)CALVEZ (JCO1998)
 Attached to maxillaryAttached to maxillary
headgear tube with a ballheadgear tube with a ball
pin.pin.
 This pin is bent so it canThis pin is bent so it can
be tied with a ligaturebe tied with a ligature
wire to a hook on thewire to a hook on the
molar.molar.
QuickTime™ and a

 In a .022slot .021X.025 archwire a buccalIn a .022slot .021X.025 archwire a buccal
offset and anterior stop given.offset and anterior stop given.
 10-15degrees coronolingual torque placed to10-15degrees coronolingual torque placed to
immobilise incisors.immobilise incisors.
 A TPA used to control palatal width.A TPA used to control palatal width.
 The sliding rod ends in a 90degree hookThe sliding rod ends in a 90degree hook
attached to the mandibular archwireattached to the mandibular archwire

CHURRO JUMPERCHURRO JUMPER
 DR.CASTANONDR.CASTANON
improvised the MPAimprovised the MPA
introduced by COELHO.introduced by COELHO.
(JCO1998)(JCO1998)
 It functions more like aIt functions more like a
jasper jumper though it isjasper jumper though it is
an improvement of MPA.an improvement of MPA.
 This appliance can beThis appliance can be
easily fabricated in theeasily fabricated in the
orthodontic laboratory.orthodontic laboratory.
 Appliance name takenAppliance name taken
from a mexican cinamonfrom a mexican cinamon
twist.twist.
QuickTime™ and a

 A pin passing throughA pin passing through
the distal end ofthe distal end of
jumper and throughjumper and through
the buccal headgearthe buccal headgear
tube of maxillarytube of maxillary
molar.molar.
 Pin secured byPin secured by
bending the mesialbending the mesial
end down.end down.
 Mesially attached toMesially attached to
mandibular archwiremandibular archwire
distal to canine.distal to canine.
QuickTime™ and a

APPLIANCE FABRICATIONAPPLIANCE FABRICATION
QuickTime™ and a
QuickTime™ and a

CONCLUSIONCONCLUSION
 EVEN THOUGH THE FIXED FUNCTIONALEVEN THOUGH THE FIXED FUNCTIONAL
APPLIANCES VARY MUCH IN THEIR DESIGNAPPLIANCES VARY MUCH IN THEIR DESIGN
THE DENTAL AND SKELETAL CHANGESTHE DENTAL AND SKELETAL CHANGES
PRODUCED BY THEM ARE ALMOST SIMILAR.PRODUCED BY THEM ARE ALMOST SIMILAR.
 HOWEVER THIS IS THE LAST ORTHOPAEDICHOWEVER THIS IS THE LAST ORTHOPAEDIC
STEP TOWARDS A HARMONIOUS FACIALSTEP TOWARDS A HARMONIOUS FACIAL
PROFILE USING THE TERMINAL PHASE OFPROFILE USING THE TERMINAL PHASE OF
GROWTH.GROWTH.

REFERANCESREFERANCES
 DENTOFACIAL ORTHOPAEDICS WITHDENTOFACIAL ORTHOPAEDICS WITH
FUNCTIONAL APPLIANCES-THOMAS MFUNCTIONAL APPLIANCES-THOMAS M
GRABER,THOMAS RAKOSI,ALEXANDERGRABER,THOMAS RAKOSI,ALEXANDER
PETROVIC.PETROVIC.
 THE UNIVERSAL BITE JUMPER-XAVIERTHE UNIVERSAL BITE JUMPER-XAVIER
CALVEZ-JCO1998CALVEZ-JCO1998
 MANDIBULAR PROTRACTIONMANDIBULAR PROTRACTION
APPLIANCE-CARLOS M COELHO-APPLIANCE-CARLOS M COELHO-
JCO1995,1997,1998,2001.JCO1995,1997,1998,2001.

 A NEW INTERARCH DEVICE FOR CLASSIIA NEW INTERARCH DEVICE FOR CLASSII
CORRECTION-WILLIAM VOGST(JCO2003)CORRECTION-WILLIAM VOGST(JCO2003)
 CLINICAL MANAGEMENT OF JASPERCLINICAL MANAGEMENT OF JASPER
JUMPER-H.O.BLACKWOOD(JCO1991)JUMPER-H.O.BLACKWOOD(JCO1991)
 CLASSII CORRECTION:REDUCING PATIENTCLASSII CORRECTION:REDUCING PATIENT
COMPLIANCE(BRITISH ORTHODONTICCOMPLIANCE(BRITISH ORTHODONTIC
SOCIETY 2000)SOCIETY 2000)
 THE ADJUSTABLE BITE CORRECTOR-THE ADJUSTABLE BITE CORRECTOR-
RICHARD P WEST(JCO1995)RICHARD P WEST(JCO1995)

 TREATMENT EFFECTS OFTREATMENT EFFECTS OF
REPOSITIONING APPLIANCE ONREPOSITIONING APPLIANCE ON
PATIENTS WITH CLASSIIPATIENTS WITH CLASSII
MALOCCLUSION;VALMYMALOCCLUSION;VALMY
PANGRAZIO(AJODO2003)PANGRAZIO(AJODO2003)
 THE EUREKA SPRING:A NEWTHE EUREKA SPRING:A NEW
INTERARCH FORCE DELIVERYINTERARCH FORCE DELIVERY
SYSTEM;JOHN DEVINCENZO(JCO1997)SYSTEM;JOHN DEVINCENZO(JCO1997)
 CLINCAL USE OF CHURROCLINCAL USE OF CHURRO
JUMPER;RICARDO CASTANAN(JCO1998)JUMPER;RICARDO CASTANAN(JCO1998)

THANK YOU

Fixed functional appliance

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Fixed functional appliance