Initial effects of treatment of Class H malocclusion with

the Herren activator, activator-headgear combination,

and Jasper Jumper
Frank J. Weiland, DDS, a Bengt Ingervall, DDS, Odont.Dr., b Hans-Peter Bantleon, MD, PhD, c
and Helmut Droschl, MD, PhD a
Graz and Vienna, Austria, and Bern, Switzerland

The initial effects of treatment of Class II, Division 1 malocclusion with an activator, according to
Herren (27 patients), with an activator-headgear combination (20 patients), or with the Jasper
Jumper appliance (25 patients) were studied on lateral cephalograms from before and after 6 to 8
months of treatment. The patients' ages ranged from 9 to 12 years. At the end of the period of
observation, the correction in overjet and molar relationship was more complete in the patients with
the Jasper Jumper than in the patients with the activator. Whereas all the patients with the Jasper
Jumper showed neutral occlusion, this was the case in only 20 of the 47 patients with the activator.
The correction of the distal occlusion occurred through a combination of skeletal and dentoalveolar
adaptations. Skeletal changes accounted for 42%, 35%, and 48% of the overjet correction by the
Herren-type activator, the headgear-activator, and the Jasper Jumper, respectively. The correction
of the molar relationship occurred to 55%, 46%, and 38% by skeletal changes in the respective
groups. Dentoalveolar compensation (distal movement of the upper molars, mesial movement of the
lower molars) appeared to be inversely related to skeletal adaptation. The patients with the Jasper
Jumper showed a marked intrusion of the lower incisors with a consequent reduction in overbite.
(Am J Orthod Dentofac Orthop 1997;112:19-27.)

A common strategy in the treatment of

Class II, Division 1 malocclusions in growing pa-
tients is a two-step approach. In the first phase of
treatment, the sagittal jaw relationship is normal-
ized. The Class II malocclusion is transformed to a
Class I malocclusion. In the second phase of treat-
ment, adjustment of tooth position is performed,
normally with a fixed appliance. The correction of
the sagittal jaw relationship can be achieved in
several ways. Removable functional appliances, such
as the activator, change a Class II relationship by the
transmission of soft tissue tension to the dentition.
This is achieved by positioning the mandible anteri-
orly with the appliance. In Jasper Jumper therapy,
fixed appliances with flexible intraoral force mod-
ules are used in the first phase of treatment.
As the activator and the Jasper Jumper are quite
different appliances in design and, possibly, mode of
action, a study comparing the two treatment meth-
ods would be warranted.
aDepartment of Orthodontics, University of Graz, Austria.
bDepartment of Orthodontics, University of Bern, Switzerland.
CDepartment of Orthodontics, University of Vienna, Austria.
Reprint requests to: Dr. Frank J. Weiland, Department of Orthodontics,
University Dental School, Auenbruggerplatz 12, A-8036 Graz/LKH, Aus-
tria.
Copyright © 1997 by the American Association of Orthodontists.
0889-5406/97/$5.00 + 0 8/1/71895
The current investigation was performed to
quantitatively evaluate skeletal and dental changes
contributing to Class II correction in activator and
Jasper Jumper treatment.
SUBJECTS AND METHODS
The study included 72 children with Class II, Division
1 malocclusions. Twenty-seven children were treated with
an activator (Herren1). An activator-headgear combina-
tion was used in 20 children. In 25 children, Class II
correction was performed with fixed appliances and Jas-
per Jumpers. All patients with activators were treated at
the Department of Orthodontics, University of Bern. The
Jasper Jumper treatment was performed at the Depart-
ment of Orthodontics, University of Graz. The consecu-
tively treated Jasper Jumper patients fulfilled the follow-
ing criteria:
Age at the onset of treatment between 9 and 12 years.
Distal occlusion with increased overjet; at least half a
cusp width distal molar relationship.
The initial cephalogram was taken less than 3 months
before the start of treatment.
The second cephalogram was taken at achieving Class
I dental relationships.
Sufficient quality of the cephalograms.
19
20 Weiland et al.
Table I. Distribution of the subjects by sex and age (in years and months) and duration of the period of observation (days)
Sex
Group n M F Medium
Herren-type activator 27 15 12
Headgear-activator 20 9 11
Jasper Jumper 25 20 5 10-8
Matching patients, treated with either the Herren
activator (27 patients) or the activator-headgear combina-
tion (20 patients), were selected from the files of the
Department of Orthodontics, University of Bern. The first
cephalogram in these patients was taken at the start of the
treatment and the second at achieving Class I dental
relationships, or 8 months after the first cephalogram,
depending on which occurred first. The sex and age of the
children and the duration of the period of observation are
given in Table I.
Mode of Treatment
The Herren activator I-3 is characterized by a construc-
tion bite overcompensating for the distal occlusion by 3 to
5 mm, with 2 to 4 mm opening between the incisal edges.
The construction bite is thus taken at least 8 mm anterior
of the distal intercuspidation. Clasps are used to fixate the
appliance to the upper first molars. Long lingual mandib-
ular flanges reduce mandibular mobility. The edges of the
lower incisors are covered with acrylic (Fig. 1). The
occlusal surfaces of the mandibular posterior teeth are
relieved from the acrylic. The patients were instructed to
wear the appliance 12 hours per day.
The activator-headgear combination used in this in-
vestigation (Fig. 2) was a modified Herren activator, with
an attached headgear for the use of an occipital pull of
approximately 300 gm per side. These patients were also
instructed to wear the appliance 12 hours per day.
In the patients treated with fixed appliances and
Jasper Jumpers, the procedure was as follows: The first
molars were banded, using bands with triple tubes in the
upper arch and double tubes in the lower arch and
attachments for a transpalatal arch in the upper jaw and a
lingual arch in the lower jaw, respectively. Pretorqued
brackets (0.018-inch slot) were bonded to the incisors
(torque values: upper central teeth + 14°, upper lateral
teeth +7 °, lower incisors -5°). After a leveling phase,
0.017 × 0.025-inch stainless steel arch wires were inserted
and cinched back. In addition, transpalatal and lingual
arches (0.036-inch stainless steel) were used to increase
stability. The Jasper Jumpers were selected according to
the manufacturer's instructions and inserted in the lower
arch to an auxiliary wire that ran from the auxiliary tube of
the molar and hooked to the main arch wire (Fig. 3). As
the Jumpers gradually lost elasticity, they were replaced
after approximately 3 months in all but one patient.
American Journal of Orthodontics and Dentofacial Orthopedics
July 1997
Age at the start of Duration of period of
treatment (yrs-mos) observation (days)
Range Median Range
10-4 9-2-12-3 245 161-344
10-1 8-11-12-4 212 175-280
9-2-12-2 180 155-283
Analysis of Lateral Cephalograms
The cephalograms were taken with the mandible in
the intercuspal position and with relaxed lips. The cepha-
lograms were traced on matte acetate paper with a 0.3 mm
lead pencil. The computerized cephalometric analysis
system of Gebauer 4 was used. The analysis of sagittal
linear changes was performed according to the method of
Pancherz. 5 A reference grid, consisting of the occlusal line
(OL) and a perpendicular to the occlusal line through the
point sella (OLp) was drawn on the tracing of the
pretreatment cephalogram. The reference grid was trans-
ferred to the second cephalogram by superimposing on
structures of the anterior cranial base. 6 The variables
recorded are given in Table II. Variables i to 9 are angles
describing the structure of the face and the inclination of
the incisors. Variables 10 and 11 are incisor overjet and
overbite, measured parallel to OL and perpendicular to a
constructed horizontal line F H ' , angulated 6 ° to NSL,
respectively. Variables 12 to 18 (Pancherz analysis) are
the distances from the hard tissue profile points and from
the point Ar as well as from the first molars and incisors
to OLp. The distance from the edge of the most anterior
upper incisor and from the mesial cusp of the first molars
was measured perpendicular to NL (variables 19 and 20).
For the corresponding lower teeth, these measurements
were made perpendicular to ML (variables 21 and 22). All
linear variables were corrected for enlargement. Separate
tracings were made by two observers and the mean of
their recordings was used in the further analysis.
Error of the Method and Statistical Analysis
The errors of the method of the cephalometric analysis
(including the superimposition procedure) were evaluated
by the calculation of systematic and accidental errors. Du-
plicate determinators were made of all pretreatment cepha-
lograms. Ten variables differed significantly between the
duplicate determinations (paired t test), although no variable
differed more than 0.17 ° or 0.28 mm. The accidental errors
(s~) were calculated with the following formula:
Si ~ ~ 2
~] 2n
where d is the difference between the two determinations.
The largest accidental errors were 0.75 ° and 0.69 mm.
Differences between the three groups were tested with
Mann-Whitney's U test and intragroup differences with
Wilcoxon's matched pairs, signed ranks test.
American Journal of Orthodontics and Dentofacial Orthopedics Weiland et al. 21
Volume 112, No. 1

Fig. 1. A, Herren activator. B, Headgear-activator combination. C, Fixed appliance with

Jasper Jumper. Transpalatal and lingual arches not visible.

RESULTS were less protrusive in the Jasper Jumper group

Comparison Between the Groups
Before Treatment
Relatively few variables differed significantly be-
tween the three groups before treatment (Table II).
The maxilla was more retrusive in the Jasper
Jumper group that in the two activator groups (V1
SNA, V12 A-OLp). The difference was, however,
significant only compared with the Herren activator
group. Consequently, the sagittal jaw relationship
(V3 ANB) and the overjet (V10) were smaller in the
patients with Jasper Jumpers. The upper incisors
than in the Herren activator group (V13). The lower
first molars were more posteriorly positioned in the
headgear-activator group than in the Herren activa-
tor group (V16).
Changes in the Cephalometric Variables During
the Treatment
Anteroposterior effects. During the treatment, the
SNA angle (V1) decreased in all three groups (with
a significant change in the headgear-activator and
Jasper Jumper groups), in conjunction with a slight
22 Weiland et aL American Journal of Orthodontics and Dentofacial Orthopedics
July1997

• ) NSL

O L ~ ~ ML

ILi

Fig. 2. A, Reference points used in cephalometric analysis. B, Reference lines used in

cephalometric analysis.

Overjetj:HG.corAHA
rection3.m7m14.
mm1m43.
m58[ ~

/
skeletal dental
HA 1.49 mm HA 2.09 mm
HG-A 1.46 mm HG-A 2.68 mm
JJ 1.79 mm JJ 1.92 mm

maxilla mandible maxilla mandible

HA -0.53 mm HA 2.02 mm HA 1.10 mm HA 0.99 mm
HG-A -0.45mm HG-A 1.91 mm HG-A 2.22mm HG-A 0.46mm
JJ -0.45 mm JJ 2.24 mm JJ 1.02 mm JJ 0.90 mm

HA: Herrenactivator
HG-A: Headgear-activator
JJ: JasperJumper

Fig. 3. Maxillary and mandibular skeletal and dental changes (in mm) contributing to
overjet correction. Minus sign (-) indicates unfavorable changes for oVerjet correction.

anterior movement of point A (V12 A-OLp), which
was significant in the Herren activator and Jasper
Jumper groups. The SNB angle (V2) increased
significantly in both activator groups. The anterior
movement of the pogonion (V17 Pg-OLp) was
significant in all three groups, as was the decrease in
the ANB angle (V3). The distance from the articu-
lare to OLp remained stable.
The upper incisors retroclined and moved dis-
tally in relation to the reference line for anteropos-
terior changes OLp in all three groups (V7 Ils/NL
and V13 Is-OLp, significantly in both activator
groups). The lower incisors proclined in the Herren
activator and Jasper Jumper groups (V8 Ili/ML),
whereas the distance of the lower incisor edge to
OLp (V14 Ii-OLp) increased significantly in all
three groups. The overjet decreased significantly in
the three groups. The upper first molars moved
distally in relation to OLp in the Jasper Jumper
group (V15 Msa-OLp), whereas the mandibular first
molars moved anteriorly in relation to OLp in all
three groups (V16 Mia-OLp).
Vertical changes. The inclination of the maxilla
(V4 NSL/NL) increased slightly (although not sig-
nificantly in the headgear-activator group). The
inclination of the mandibular plane (V5 NSL/ML)
American Journal of Orthodontics and Dentofacial Orthopedics Weiland et al. 23
Volume 112, No. 1

Table II. Skeletal and dental cephalometric variables in the three groups before t re a t me nt

1. Herren activator 2. Headgear-activator 3. Jasper Jumper

Significant differences
Variable Median Range Median Range Median Range between the groups

Angular measurements (degrees)

1. SNA 81.93 74.7-88.6 81.56 75.4-88.3 79.37 70.8-86.0 1-3"
2. SNB 75.34 70.9-81.0 76.13 68.7-81.6 74.77 68.7-82.2
3. ANB 5.45 1.8-8.6 6.55 2.2-9.2 4.70 1.7-7.3 1-3"; 2-3*
4. NSL/NL 7.75 3.2-14.0 7.43 2.0-14.0 7.67 1.6-10.5
5. NSL/ML 31.07 22.6-37.7 31.89 23.2-45.3 32.87 24.4-44.3
6. NL/ML 23.76 14.6-31.4 24.71 16.0-36.7 23.59 16.2-35.2
7. ILs/NL 113.75 100.5-124.9 114.87 96.4-128.7 111.53 98.2-120.9
8. ILi/ML 97.58 85.9-107.4 96.61 88.0-t04.2 93.78 82.5-104.3
9. ILs/ILi 129.01 113.6-138.4 124.54 114.9-135.l 129.75 115.8-141.1
Linear measurements (ram)
10. Overjet 7.56 2.4-12.0 7.59 4.2-11.5 5.29 2.8-10.6 1-3"; 2-3**
1t. Overbite 5.59 3.2-8.2 5.67 1.0-7.5 5.20 0.8-8.0
12. A-OLp 71.25 66.3-79.6 70.61 63.6-78.9 69.47 63.9-80.5 1-3"
13. Is-OLp 80.34 75.6-89.1 78.0l 71.0-86.1 76.81 68.8-87.8 1-3"**
14. Ii-OLp 72.00 65,9-79.6 69.66 61.2-78.3 69.35 62.9-82.9
15. Msa-OLp 50.09 45.5-57.5 48.28 40.7-55.1 47.43 41.8-61.7
16. Mia-OLp 47.99 43,0-56.6 45.39 37.8-53.5 45.91 40.8-58.8 1-2"
17. Pg-OLp 73.63 66.3-80.9 71.30 62.3-81.0 72.24 66.2-86.1
18. Ar-OLp 7.53 3.7-13.2 8.15 3.1-14.0 6.90 5.2-13.3
19. Is-NL 25.12 22.2-28.6 25.24 19.4-28.8 25.01 21.3-30.3
20. Mso-NL 18.38 16.0-21.1 18.00 14.8-20.2 17.94 15.0-23.4
21. Ii-ML 35.71 33.2-40.9 35.96 31.8-41.6 35.47 31.6-40.0
22. Mio-ML 26.82 23.7-30.8 27.30 23.3-31.9 26.40 22.5-29.5

*0.01 < p < 0.05; **0.001 < p < 0.01; ***p < 0.001.

remained stable in all three groups. The vertical jaw
relation (V6 NL/ML) decreased somewhat in the
Herren activator and Jasper Jumper groups (signif-
icantly only in the Herren activator group). The
upper incisors elongated slightly in the Herren
activator group (V19 Is-NL). The vertical position
of the lower incisors (V21 Ii-ML) was relatively
stable in both activator groups, whereas the distance
between the edge of the lower incisor and the lower
border of the mandible decreased significantly in the
Jasper Jumper group. The vertical position of the
upper molars (V20 Mso-NL) did not change signif-
icantly in any group. In contrast, a significant elon-
gation of the lower molars was noted in all groups
(V22 Mio-ML). The overbite decreased significantly
in all three groups.
Comparison Between the Groups After Treatment
The significant differences between the groups
before the treatment (Table II) persisted after the
period of observation. In addition, two significant
differences were found between the activator
groups. Thus the median value of variable 14 (Ii-
OLp) indicated that the lower incisors were more
anteriorly positioned in relation to OLp in the
Herren activator group than in the headgear-activa-
tor group. The upper molars were more posteriorly
positioned in relation to OLp in the headgear-
activator groups and in the Jasper Jumper group
than in the Herren activator group (V15 Msa-OLp).
Additional differences after the period of observa-
tion were a smaller overbite in the Jasper Jumper
group than in the Herren activator and headgear-
activator groups (median values 1.8, 4.1, and 4.2
ram, respectively, p < 0.001) and a smaller distance
of the lower incisor edge to the mandibular plane
(V21 Ii-ML) in the Jasper Jumper group (median
values 33.5, 35.7, and 36.7 mm in the Jasper Jumper
group, the Herren activator group, and the head-
gear-activator group, respectively; p < 0.001).
Components of Class II Correction
In addition to direct measurement, the overjet
can also be calculated as the difference of the
variables Is-OLp and Ii-OLp. The change in the
overjet is brought about by skeletal changes, i.e., a
change in the difference between the variables A-
OLp and Pg-OLp, and by the movement of the
incisors within the jaws. This movement can be
estimated as the change of the difference Is-OLp
minus A-OLp and Ii-OLp minus Pg-OLp. This
method (described by Pancherzs) gives the results
24 Weiland et al. American Journal of Orthodontics and Dentofacial Orthopedics
July 1997

Molar correction
HA 2.73 mm
HG-A 3.19 mm
J J: 4.75 mm

/ \
skeletal dental
HA 1.49 mm HA 1.24 mm
HG-A 1.46 mm HG-A 1.73 mm
JJ 1.79 mm JJ 2.96 mm

/\
maxilla -~ mandible maxilla mandible
HA -0.53 mrn HA 2.02 mm HA 0.50 mm HA 0.74 mm
HG-A -0.45 mm HG-A 1,91 mm HG-A 1.38 mm HG-A 0.35 mm
JJ -0.45 mm JJ 2.24 mm JJ 1.54 min JJ 1.42 mm

HA: Herren activator

HG-A: Headgear-activator
JJ: Jasper Jumper

Fig. 4. Maxillary and mandibular skeletal and dental changes (in mm) contributing to
correction of molar relationship. Minus sign (-) indicates unfavorable changes for molar
correction.

shown in Fig. 3. In a similar way, it is possible to DISCUSSION

isolate the factors contributing to the correction of
the molar relationship, by using the change of the
difference Msa-OLp minus A-OLp and Mia-OLp
minus Pg-OLp for the upper and lower molars (Fig.
4).
The skeletal contribution to the reduction in
overjet (change in the difference A-OLp minus
Pg-OLp) was largest in the Jasper Jumper group
and of the same magnitude in the two activator
groups. The anterior displacement of the maxilla
(distance A-OLp) is counterproductive to the over-
jet correction (minus sign in Fig. 3). This was,
however, outweighed by a greater anterior displace-
ment of the mandible (distance Pg-OLp). These
skeletal changes were similar in all three groups.
During the treatment, there was a retrusion of the
upper incisors in all groups (most pronounced in the
headgear-activator group), in combination with a
protrusion of the lower incisors (least pronounced in
the headgear-activator group).
The correction of the molar relationship was
largest in the Jasper Jumper group (Fig. 4). This was
mainly due to the marked dental changes seen in
this group: the largest distal movement of the upper
molars combined with the largest mesial movement
of the lower molars. Little posterior upper molar
movement occurred in the Herren activator group,
whereas the anterior movement of the lower molars
was least in the headgear-activator group.
The pretreatment age of the children in the
three groups was similar. The sex distribution, how-
ever, differed between the groups, as did the length
of the period of observation, which was longer in the
activator groups. The latter was due to the protocol
of the cephalometric recording: In the patients with
Jasper Jumpers, the second cephalogram was taken
at achieving neutral occlusion (on average, after 6
months). In the patients with activators, the second
cephalogram was taken at achieving neutral occlu-
sion, or after 8 months, whichever occurred first. In
one patient treated with the Herren activator, how-
ever, the second cephalogram was taken after 11
months.
At the start of treatment, only a few cephalomet-
ric variables differed among the groups. Essentially,
the maxillary prognathism and related measure-
ments (maxillary incisor position) were smaller in
the Jasper Jumper group. The growth direction,
however, as indicated by the vertical jaw relation,
was comparable in all three groups.
It was for ethical reasons not possible to compile
a control group of matching untreated Class II
cases. To enable some comparison to untreated
subjects, as suggested by Mills, 7 data from the
literature were collected and the changes of the
cephalometric variables for a 6-month period calcu-
lated. Partly different reference points and measure-
ments were used, especially for linear variables. No
American Journal of Orthodontics and Dentofacial Orthopedics W e i l a n d et al. 95
Volume 112, No. 1

Table IlL Changes of the cephalometric variables during the observation period (value at second recording minus value at first
recording). The table also gives reference values for growth changes of untreated Class II malocclusions (see Discussion)

1. Herren activator 2. Headgear-activator 3. Jasper Jumper Significant Reference values

i differences between (growth changes
Variab& Median Range Median Range Median Range the groups per 6 months)

Angular measurements (degrees)

1. SNA -0.18 -1.4-+0.9 -0.52*** -1.8-+0.5 -0.65** -2.9-+2.6 1-2"; 1 - 3 " +0,045'7"16
2. SNB +0.81"** -1.4-+2.3 +0.81"* -0.9-+2.4 +0,36 -0.9-+3.2 +0.065'7"16
3. ANB -1.01"** -2.6-+2.0 -1.28"** -3.2-+0.1 -0.99*** -3.6-+2.2 --0.025'7"9'12-15'17
4. NSL/NL +0.50*** -0.3-+2.1 +0.38 -2.2-+1.3 +0.48* -2.1-+3.8 -0.015'8"11'15'17'18
5. NSL/ML +0.10 -1.1:+1.8 +0.12 -2.4-+2.7 -0.31 -2.2-+2.2 --0.085'7-12'14'15'I7
6. NL/ML -0.47* -1.8-+1.6 +0.05 -2.6-+3.5 -0.55 -4.5-+2.3 -0.075,8,1°,11'15
7. ILs/NL -4.39*** -13.2-+1.2 -5.07*** -15.3-+1.9 -3.43 -16.2-+11.1 -0.098,15-17
8. ILi/ML +2.35*** -1.8-+10.0 +0.25 -2.9-+9.6 +4.31"** -1.4-+10.6 2-3** +0,108,15-17
9. ILs/ILi +1.81"* -3.9-+8.8 +4.15"** -5.3-+15.8 +1.14 -15.1-+13.2 1-2";2-3* --0.2013
Linear measurements (mm)
10. Overjet -3.57*** -9.0-+1.1 -4.24*** -6,2--0.5 -4.05*** -7.4--0.6 +0.019'13
11. Overbite -1.55"** -4.0-+2.3 -1.11"* -3.9-+2.5 -3.13"** -5.4-+0.3 1-3"**;2-3"** +0.01913
12. A-OLp +0.53*** -1.0-+2.3 +0.45 -1.6-+2.7 +0.45* -1.8-+3.1 +0.375'1°'11"13-15'17-22
13. Is-OLp -0.57" -3.3-+1.7 -1.77"* -4.8-+3.2 -0.57 -5.9-+2.9 +0.495'1z'13"17'2°-22
14. Ii-OLp +3,01"** 0.0-+7.3 +2.37*** -0.2-+6.2 +3.14"** +0.5-+5.5 +0.485'13'17'20-22
15. Msa-OLp +0.03 -1.7-+1.6 -0.93 -2.8-+2.2 -1.09"* -3.3-+2.5 1-3" +0.615'7'1°-12'17'19
16. Mia-OLp +2.76*** -0.6-+5.7 +2.26*** +0.2-+5.5 +3.66*** +0.9-+7.5 2-3* +0.665'7'17'19
17. Pg-OLp +2.02*** -0.4-+6.0 +1.91"** -1.9-+7.2 +2.24*** -1.2-+5.8 +0.385"10'11'13'15'I7"19"20-22
18. Ar-OLp -0.07 -1.2-+1.3 +0.09 -0.9-+1.0 +0.03 -1.1-+1.8 +0.215,1°,11,19
19. Is-NL +0.56*** -0.9-+2.0 +0.24 -1.5-+1.7 +0.30 -1.9-+2.2 +0.73 lz
20. Mso-NL +0.04 ' -1,0-+1.6 +0.02 -1.5-+1.8 -0.51 -3.3-+2.4 +0.6312,18
21. Ii-ML +0.19 -1.1-+1.1 +0.21" -1.0-+1.8 -1.72"** -3.7-+2.0 1-3"**;2-3"** +0.4512
22. Mio-ML +0.63*** -0.2-+1.8 +0.49** -0.4-+2.0 +0.98*** +0.1-+2.9 2-3* +0.2912

"0.01 < p < 0.05; **0.001 < p < 0.01; ***p < 0,001,

correction of linear enlargement was made as many
studies lacked these data. The observation periods
varied from 6 months to 6 years. The growth during
longer periods will not be at a constant rate. As a
consequence, the data for an observation period of
6 months, shown in Table III as "reference values,"
are just indicative.
During the period of observation, the maxillary
prognathism (V1 SNA) decreased to some extent in
all three groups. The decrease was least (and not
significant) in the group treated with the Herren
activator and comparable to values found by other
authors who used the activator appliance, consider-
ing the shorter period of observation in our
study. 8'm'23-25 The reduction in maxillary progna-
thism was similar in the headgear-activator and the
Jasper Jumper groups and of the same magnitude as
found by other authors with an activator-headgear
combination 17,26-29and with a fixed functional appli-
ance like the Herbst headgear appliance 5,9,3°-32 or
the Jasper JumperY This can be attributed to the
use of the extraoral force in the headgear-activator
g r o u p 26'29'34'35 and to the occipital-pull headgear-like
forces acting on the maxilla from the Jasper Jumper
appliance. 33 The SNB angle increased similarly in
both activator groups and was in accordance with
the results of previous s t u d i e s . 8'16'17'24'36-4° A nu-
meric increase in mandibular prognathism was
found in the Jasper Jumper group. This increase was
much smaller than that given for the Herbst appli-
ance (+l.2°in a 6-month treatment period 9,3°,31)
and that found in an earlier study on the Jasper
Jumper. 33 The sagittal jaw relation (V3 ANB) de-
creased similarly in all three groups, but, as is
evident from the differing development of the max-
illary and mandibular prognathism, this was
achieved in a somewhat different way in the three
groups. Whereas the group treated with the Herren
activator showed a combination of the smallest
decrease in maxillary prognathism with a large in-
crease in mandibular prognathism, the opposite was
the case for the Jasper Jumper group. Without
treatment, only minimal changes in maxillary and
mandibular prognathism and, consequently, in sag-
ittal jaw relation can be expected during a 6-month
period, as indicated in the literature (Table III,
column reference values).
A small posterior rotation of the maxilla oc-
curred in all three groups, although this change was
not significant in the headgear-activator group.
26 Weiland et aL
This slight maxillary rotation occurring during
Class II treatment has been reported previous-
ly5,9,10'16,25,27'28'31 and contrasts to the stable position
of the maxilla without treatment. The vertical jaw
relation remained unchanged in the headgear-acti-
vator group, whereas a slight decrease (closure) was
noted in the other two groups (not significant in the
Jasper Jumper group).
The upper incisors retroclined in all three groups
(not significant in the Jasper Jumper patients),
whereas their inclination could have been expected
to stay stable without treatment. Compared with the
reference values, the appliances studied seem to
reduce the vertical dentoalveolar development of
the anterior part of the arch (V19 Is-NL). This effect
appears to be more pronounced when an active
force is applied to the maxilla (headgear-activator,
Jasper Jumper). The inclination of the lower inci-
sors was stable in the headgear-activator group, as
would have been expected without treatment,
whereas the lower incisors proclined in the other
two groups, a well-known phenomenon in functional
jaw orthopedics. 16,17,24'25,27'2sA marked intrusion of
the lower incisors was found in the Jasper Jumper
patients, which can be attributed to the force vector
of the inserted Jumpers, which is directed backward-
upward and forward-downward.
The analysis of the treatment effect with the
conventional cephalometric angular relations as de-
scribed previously was supplemented with the
method of Pancherz, 5 which gives a more realistic
picture of the treatment effects as they are observed
clinically. The analysis of Pancherz demonstrates
anteroposterior treatment effects isolated from ver-
tical changes in the facial structure and independent
of the growth at the nasion. Analyzed with this
method, the three appliances tested seemed to have
no effect on the anterior development of the maxilla
compared with the reference value. Interestingly,
the linear anterior development of the bony chin
(V17 Pg-OLp) was similar in the three groups and
five to six times larger than the reference value,
although the SNB angle gives a different impression.
During normal growth, no change in overjet can
be expected over a 6-month period, whereas the
appliances used reduced the overjet to a significant
extent. Less than half of this correction was due to
skeletal changes. The skeletal contribution to Class
II correction has been found to vary between 20%
and 77%. 5,24'25,29,31,33'36,41 The results of our study
were within this range. The components of the
skeletal changes were essentially the same in all
three groups. The anteriorly directed maxillary
American Journal of Orthodontics and Dentofacial Orthopedics
July 1997
growth was compensated for by a large anterior
mandibular growth. The dental component of the
overjet correction varied somewhat between the
groups. Thus the upper incisors were retracted most
in the headgear-activator group, but the anterior
movement of the lower incisors was only half of that
in the other two groups. Corrected for the shorter
observation time in our study, the dental component
of the overjet correction was similar to data found in
the literature. 25 During normal growth, in contrast,
the anteroposterior position of the incisors in rela-
tion to their respective bony bases is approximately
stable (difference between V13 and V12, and V17
and V14, respectively).
In untreated Class II malocclusions, the upper
and lower molars move anteriorly by about 0.2 mm
within their respective bases during a 6-month pe-
riod (difference between V15 and V12, and V16 and
V17, respectively). Ideally, with treatment, the up-
per molars should move posteriorly and the anterior
movement of the lower molars should increase. This
was the case in the three groups of our study, but to
a different extent. The most pronounced correction
of the molar relationship was seen in the Jasper
Jumper patients. This was mainly due to dental
changes: the largest distal movement of the upper
molars in conjunction with the largest mesial move-
ment of the lower molars of the three groups. The
correction of the molar relationship was smallest in
the Herren activator group, but this correction was
mainly due to skeletal adaptation. This confirms the
opinion that rapid dentoalveolar compensation pre-
vents a more marked correction of the skeletal
discrepancy in Class II malocclusion. 42 The rapid
anterior movement of the lower molars in the Jasper
Jumper group can be explained by the pull on these
teeth from the Jumpers. A possible negative result
of this anterior movement exceeding the anterior
movement of the lower incisors in the late mixed
dentition period is the loss of leeway space. If the
space analysis shows this to be contraindicated, a
stopped main arch wire should be used in the lower
jaw. The acrylic indentations in the activators pre-
served leeway space effectively.
A direct comparison between the groups regard-
ing the effect of the treatment is hampered by the
varying duration of the period of observation and
the different sex distribution in the groups. The
influence of growth may therefore be different. An
analysis of the monthly rates of overjet correction
shows some intergroup differences: the mean
monthly correction was 0.42 mm in the Herren
activator, 0.52 mm in the headgear-activator, and
American Journal of Orthodontics and Dentofacial Orthopedics
Volume 112, No. 1
0.62 m m in the Jasper Jumper groups. The speed of
the correction of the molar relationship varied more
between the groups. While the magnitude of the
monthly correction was similar in the two activator
groups (0.32 m m in the Herren activator and 0.40
m m in the headgear-activator group), the monthly
correction was 0.79 m m in the Jasper Jumper group.
All Jasper Jumper patients reached Class I molar
relationship in 6 months, whereas in each activator
group just 10 patients showed neutral occlusion
after 8 months of treatment.
CONCLUSIONS
The study has shown that the correction of Class II
malocclusion is more rapid with the Jasper Jumper appli-
ance than with the Herren activator or the headgear-
activator combination. Class I dental arch relationships
were attained within 6 months in all Jasper Jumper
patients, whereas this was not the case in the majority of
the activator cases. This is mainly due, however, to more
pronounced dental compensation in the motar area in the
Jasper Jumper group, having a bearing on the lower
leeway space. This could have been prevented, however, if
a stopped lower arch wire had been used. The study seems
to corroborate the opinion that dentoalveolar compensa-
tion precludes more marked skeletal adaptations. To
achieve the optimum skeletal changes, dental anchorage
should be monitored closely. The Jumper patients showed
a marked intrusion of the lower incisors, and, as a
consequence, a significant reduction in overbite. This may
be desirable or undesirable in the individual case. The
clinician should be aware of the side effects of the Jasper
Jumper appliance and consider them in his treatment
plan. A major advantage of the Jasper Jumper compared
with activator treatment is that the Jasper Jumper hardly
relies on the cooperation of the patient.
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