APPLIANCES IN PEDIATRIC

DENTISTRY

A. VAMSI KRISHNA
IMDS
Contents
 Space maintainers

 Habit breaking appliances

 Removable appliances

 Myofunctional appliances

 Orthopaedic appliances

 Conclusion

 References
SPACE MAINTAINERS
 N O I T I N I F E D

This term was coined by JC Brauer in 1941.

It is defined as the process of maintaining a space
in a given arch previously occupied by a tooth or a
group of teeth

Boucher: it is a fixed or removable appliance

designed to preserve the space created by the
premature loss of a primary tooth or a group of
teeth
 If a child loses a primary tooth early
through decay or injury, the child's
other teeth could shift and begin to
fill the vacant space.

 When the child's permanent teeth

emerge, there's not enough room
for them.

 The result is crooked or crowded

teeth and difficulties with chewing
or speaking.
This is a ideal case where a space maintainer would
have helped
INDICATIONS

1. If the space shows signs of closing.

2. If the use of space maintainer will make the

future orthodontics less complicated.

3. If the need for treatment of malocclusion at a

later date is not indicated.
4. When the space should be maintained for
two year or more.

5. To avoid supra eruption of opposing tooth.

6. To improve the masticatory system and

restore dental health.
 CONTRAINDICATIONS

1. If the radiograph shows that the succedant tooth will

erupt soon.

2. When the space left is greater than the needed for

the permanent as indicated from radiographically.

3. If the space shows no signs of closing.

4. When the succedenous tooth is congenitally absent.

 Requirements
• It should maintain the entire space
created by the tooth

• It must restore function

• Prevent supraeruption of opposing

tooth

• It should be simple in construction

• It should be strong enough to withstand occlusal
forces

• Should permit maintenance of oral hygiene

• Must not restrict the growth of jaws

• It should not exert undue forces of its own

CLASSIFICATION OF SPACE MAINTAINERS
Commonly used Space maintainers

 BAND & LOOP

 CROWN & LOOP
 LINGUAL ARCH HOLDING DEVICE
 NANCE’S PALATAL HOLDING DEVICE
 TRANS PALTAL
 DISTAL SHOE
 REMOVABLE SPACE MAINTAINER
 Primary Dentition
Maxilla Mandible
Missing Tooth Treatment Treatment

Unilateral loss of primary 1st Band / crown and loop Band/crown and loop
molar

Unilateral loss of primary 2nd
molar
Bilateral loss of primary 1st
molars
No treatment until eruption of
1st permanent molar, later
transpalatal arch
Bilateral bands/crowns and
loops.
Distal shoe until eruption of 1st
permanent molars and
permanent incisors, then lower
lingual holding arch
Bilateral bands/crowns and
loop

Bilateral loss of primary 2nd
molars
Multiple bilateral primary
molars loss
No treatment until eruption of
1st permanent molars, later
Nance palatal arch.
Saddle appliance until 1st
permanent molars are erupted,
later Nance.
Bilateral distal shoes until
eruption of 1st permanent
molars and incisors, then
lingual arch
Saddle appliance until 1s
permanent molars and incisors
are erupted, later lingual arch.
 Early Mixed dentition
Maxillary Mandibular
Missing Tooth Treatment Treatment

Unilateral loss of primary 1st No treatment unless leeway No treatment unless leeway
molar space is to be preserved space is to be preserved

Unilateral loss of primary 2nd Transpalatal Band and loop until eruption
molar of permanent incisors, then
lower lingual holding arch

Bilateral loss of primary 1st No treatment unless leeway No treatment unless leeway
molars space is to be preserved space is to be preserved

Bilateral loss of primary 2nd Nance Bilateral bands and loops until
molars eruption of permanent
incisors, then lower lingual
arch

Multiple bilateral primary Nance Saddle appliance until

molars loss eruption of permanent
incisors, then lower lingual
holding arch
 Late Mixed Dentition
Maxilla Mandible
Missing Tooth Treatment Treatment

Unilateral loss of primary 1st No treatment unless leeway No treatment unless leeway
molar space is to be preserved space is to be preserved

Unilateral loss of primary 2nd Transpalatal Lower lingual holding arch

molar

Bilateral loss of primary 1st No treatment unless leeway No treatment unless leeway
molars space is to be preserved space is to be preserved

Bilateral loss of primary 2nd Nance Lower lingual holding arch

molars

Multiple bilateral primary Nance Lower lingual holding arch

molars loss
Band and Loop space maintainers
They are unilateral, fixed, nonfunctional and passive

Used when single tooth is missing in the posterior

segment.

Can also be given in bilateral posterior tooth loss

 Indication:
1. Premature loss of one tooth.

Contraindication:
1. Long span.
2. Space lost
3. Severe malocclusion.
4. Abutment tooth mobile
Advantages:
1. Simple and easy constructed.
2. Moderate chair time.
3. Give room for erupting permanent tooth.
4. Easy to clean.
5. Inexpensive.

Disadvantages:
1. Not restore the function.
2. Not prevent the extrusion of opposing tooth.
3. Has to be replaced if the tooth anterior to space
exfoliated.
Design
It consists of a band fabricated from 0.005’’ steel band
and a loop that extends from the band to the distal
surface of the anterior abutment tooth.
Loop is placed 1mm from the gingival surface.

Construction
Band two types- Preformed, Custom made
Custom made bands are made by taking the required
amount of band material from the spool and pinching
them to form the band.
Fabricated using various pliers- Beak pliers, band
adaptor and how’s plier.

Band pinching
Festooning
Trimming
Folded flap method
Band is adapted on to the
tooth
Impression of the arch
Cast is obtained with the band
secure on the tooth
Loop is prepared with 0.9 mm
hard round stainless steel wire.
Loop soldered to the band
Cemented to the tooth
Modifications

Loop made only on one side

Occlusal rest

Occlusal stop

Crown loop

Reverse
Controversy:

Recently a study has shown that space changes with regard to arch width or
arch perimeter 6 months following premature loss of a primary maxillary first
molar was minimal.

The early space changes in the maxillary dental arch consist mainly of palatal
migration of the maxillary incisors indicating that the mesial movement of
permanent molars might not occur as a consequence of the tooth extraction.

There was statistically significant 1 mm of space loss detected; however, it is not

likely to be of enough clinical significance for the use of a space maintainer. If
palatal movement seems to be needed, a palatal arch was suggested instead of
band and loop space maintainer.

JADA 2007 vol 138:362-8

Lingual arch space maintainer
 Bilateral, fixed or semifixed, nonfunctional
passive

Indications
1. Bilateral loss of primary first or second
molars after the eruption of permanent
mandibular incisors,
2. If there is multiple loss of primary teeth.
3. In late mixed dentition stage, may be used
to hold leeway space to allow sufficient
space for permanent canines & premolars
to erupt or to preserve space for later
alignment of crowded incisors.
Advantages:

Used with uncooperative patient.

Used in children with bad oral hygiene.
Can maintain the space through period of mixed dentition.
Preserve the integrity of the whole arch.
There is no breakage problem or retention problem.
It allows free individual movement of teeth while
maintaining space.
It is easily removed, adjusted and replaced.

Disadvantages:
Not restore masticatory function.
Not prevent over eruption of opposing teeth.
Construction

 The wire should be made to contact the cingula of the

mandibular incisors
 In the edentulous ridge region wire curved down to the
lingual 1 mm away from the soft tissue
 Should maintain 3-4 mm contact with the lingual surface
of the band
 Konstantinos et al (1998) have suggested that in the canine
region 2 omega bends need to be given ???
Nance Palatal Arch
Bilateral, fixed, passive and nonfunctional
space maintainer

Indicated when there is bilateral missing

deciduous molars in the upper arch

The first permanent molars are banded

The arch wire extends from the palatal surface

of one molar band to the other, anteriorly it
extends upto the rugae area and is embedded
in an acrylic button.
Can be made active-

The acrylic button may irritate

 Transpalatal arch
 Bilateral, fixed, passive and nonfunctional
 Used when there is unilateral loss deciduous
molars
 The first permanent molars are banded
 The wire component extends from the
palatal aspects of the bands to cross..
 It prevents the mesiolingual rotation of the
molars around..
 It can be used in bilateral loss of posterior
teeth !!!
PEDIATRIC DENTISTRY V 29 / NO 3 MAY / JUNE 2007
DISTAL SHOE SPACE MAINTAINER
Early version of distal shoe – Willet’s distal shoe
Present version – Roche’s modified distal shoe appliance
Unilateral, fixed, nonfunctional and passive
An intraalveolar appliance

INDICATION
The distal shoe appliance is used to maintain the space of a
primary second molar that has been lost before the eruption
of the permanent first molar.
The result of this mesial drift is loss of arch length and
possible impaction of the second premolar
Contraindication:

1. Medically compromised pt. (because no complete

epithelization around alveolare bone) lead to (subacute bact
endocarditis).
2. Poor oral hygiene.
3. Long span.
4. Damaged abutment.
Construction
• The crown/band is adapted on the first deciduous molar
and impression is taken…

• An IOPA is taken..

• On the cast position of the mesial surface of the first

permanent molar is marked, then V shaped notch is made

• Loop is fabricated
 Loop is soldered to the crown, appliance is sterilized..
 Extract the tooth just before cementation..
 Appliance tried in patient’s mouth and IOPA taken to
confirm…
 Final cementation.
REMOVABLE SPACE MAINTAINERS

a. Non-functional types
b. Functional types
It is like a removable partial denture, Not only Mesiodistal
space but also the vertical space is maintained.

Masticatory Function is restored in functional type

Esthetics & speech improvement

removable unilateral space maintainers
They are too small and present swallowing and
choking dangers for children.
EZ retainer

 The esthetic and hygienic EZretainer maintains the

mesiodistal dimension of an extraction space and can also be
used to regain slightly closed spaces, according to Dr. Güray.
 The appliances are color-coded for each quadrant and are
available in boxes of four.
 FRC

 Gajanan et al.concluded that ribbond space maintainer as well as repaired

ribbond space maintainer are comparable to the conventional band and loop
in terms of physical strength.

 McDonald and Avery suggested that the band and loop space maintainer
should be removed once a year to inspect, clean and apply fluoride to the
tooth. FRC loop space maintainer seems to eliminate these annual
maintenance steps.

Contemporary Clinical Dentistry | April 2012 | Vol 3 | Supplement 1

Preformed space maintainers

 These space maintainers are available with stainless steel

crowns or stainless steel bands with an assortment of
attachments. There is no welding or soldering required and
they are fully adjustable to different edentulous spans.
Oral habit breaking appliances
Oral screen
Newell in 1912

Principle
 Both on principle of force elimination and force application

Indications
 Mostly to intercept mouth breathing; thumb sucking,
tongue thrusting , lip biting and cheek biting
 Flaccid hypotonic upper lip
 Correction of mild anterior proclination
Mechanism of action

When patient closes the lips or swallows

All muscle forces transmitted to anterior teeth

Retraction of the proclined teeth

Modifications
 Hotz modification
Kraus modification
Rehak modification
 Commercially available polyamide or thermoplastic
appliance
Lip bumper
Synonyms
Lip plumper

Principle
Both on principle of force elimination and force
application

Indications
Hyperactive mentalis
Lip sucking habit
Mode of action- Lip bumper will
prohibit lip from exerting
excessive force on the
mandibular incisors and
reposition the lip away from the
lingual aspect of the maxillary
incisors

Types
 Removable
 Fixed
 Denholtz modification
The Palatal Crib is designed to reduce the comfort of thumb sucking by placing
a metal crib over the most anterior portion of the palate, preventing the thumb
from resting along or contacting the palate.
The Blue Grass appliance is designed to prevent the patient
from sucking their thumb or tongue thrusting. This fixed
appliance uses a spinning roller to help break the patient's habit
and allow the anterior teeth to return to their normal position
 Modified blue grass appliance was used using 3 mm acrylic
beads as recommended by Baker.
 It encourages neuromuscular stimulations by using
multiple beads.
 Between 4–6-year-old children can be instructed to play
with the beads with the tongue immediately after
placement.
 Since Teflon rollers are not in contact with palatal tissues,
children can roll them with their tongues. Within few days,
the tongue establishes new non-harmful habit of playing
with roller.

 Hence, this appliance works through counter conditioning

response to the original conditioned stimulus for thumb
sucking.

Case Reports in Dentistry Volume 2013, Article ID 537120

The Quad Helix appliance is designed to achieve arch development by
providing a light, continuous force to both anterior and posterior
segments. Fabricated as either fixed or removable (MIA), this
appliance can also be used for molar rotation
Four helixes

Anterior bridge

Outer arms

Expansion and rotation

 Mouth guard
PURPOSE
About one third of people brux (grind or clench) their teeth. Many of these
people do so subconsciously .
The purpose of a night guard is to reduce the negative effects of bruxism.
These negative effects can include:

 Mobile teeth
 Drifting teeth
 Recession or clefting of the gum tissue
 Wear of teeth
 “v” shaped erosions in the root surfaces
 Increased bone loss
 Muscle soreness or stiffness
 Joint clicking
 Joint soreness or stiffness
Removable Appliances
Cclasp

Called as three quarter clasp

Construction
 This need 0.8 mm stainless steel wire, extends from the
interproximal embrassure either mesially or distally and
passes below the maximum bulge area and above the
gingival margin buccally.
Adjustment
 The clasp is adjusted by holding it at the contact point and
bending it towards the tooth.
Drawbacks

 It cannot be used on deciduous teeth as there is no infra-

bulge area.
 Only on posterior..
 Cannot be used in partially erupted teeth
 Thick wire..
 Create space..
Full clasp or Jackson’s clasp or
Circumferential clasp

 Used on premolars and molars

Construction
 0.8 mm wire is used
 Take apiece of wire of 5 inches
 Begin to form the clasp from the buccal aspect…….

Adjustment
 Clasp is adjusted by bending the clasp towards the tooth by
holding it at the contact point.
Triangular Clasp
 Used for additional retention
 About 3 inches of 0.7 mm, stainless steel wire is used for
forming the clasp.
 A small triangle is made….
 The triangle should be perpendicular to the tooth surface…
 The free end of triangle should be placed distally to prevent
injury to the cheek.

Adjustment
 The clasp is adjusted by bending it towards the tooth at the
contact point.
Adam’sClasp
 Introduced by C. P. Adams
 Modified arrowhead clasp or Liverpool
Clasp or Universal Clasp
 0.7 mm stainless steel wire is used

 Arrowheads should be positioned at …

 Arrowheads should have a point contact..
 The bridge should be located at the middle
third of the tooth
 The bridge should be 2 mm ..
 When viewed from the side the bridge…

Advantages
Modifications of Adams clasp
Short Labial Bow
Uses
 Used for retraction of anterior teeth
 Used for retention of teeth
 Used for reinforcement
 Used for the attachment of auxiliary springs

 Stainless steel wire 0.6 mm- Retraction

0.7 mm- Retention
0.8 to 1.0 mm- Reinforcement
Contra-Indication

Activation
Long Labial Bow
Stainless steel wire of 0.6 mm- Retaction
0.7 mm- Retention

Activation

Advantage
• Can be used to close space between canine
and premolar.
• Can control canines
• Used for retention
 Split Labial Bow
Type a – the labial bow is split in the mid-line
and the two halves do not overlap each other
 Activation – by closing the U loops
 Advantage –
 Uses- For minor correction of spaces, to flatten
arch

Type b – the two halves of the split labial bow

cross each other at the midline and engage the
distal aspect of the central incisor of the opposite
side.
 Activation

 Advantage
Robert’s Retactor
 0.5 mm stainless steel wire

Activation
 By placing a bend on the vertical limb of wire….

Advantage
 Can be used for correction of severe protrusion of teeth
 Light force is applied
 Range of action is longer
Mill’s Retractor High Labial Bow

Reverse Labial Bow

Springs
Classification

Based on the direction of tooth movement brought

about by the springs

Based on the nature of the support required for the

action
1. Self-supporting spring
2. Guided spring
3. Auxiliary spring
Formula
F α Edr4 / l3

Factors to be considered

Wire dimension
Force applied
Deflection
Direction of the tooth movement
Springs
 Expansion Screw

Description of the screw

Pitch of the screw

Activation

 A key is provided by the manufacturer

 In adults one-quarter turn is opened once in a week

 In case of children, one-quarter turn is opened once in

three days as the periodontal ligament is wider
Advantages
• Can be used in many types of tooth movements…
 Intermittent forces..
 Controlled force..
 Activation is simple, can be done by patient or parent
 Useful in moving the teeth which are to be clasped

Disadvantages
 Appliance is bulky
 Sometimes the screw tends to turn back
 Expensive
For clinical application, the expansion screw appliances are
grouped as

 Group 1 – Expansion screw appliances used to widen the

arch
 Group 2 – Expansion screw appliances used to move teeth
in labial direction
 Group 3 – Expansion screw appliances used to move teeth
in mesio-distal direction
 Group 4 – expansion screw appliances used to move
individual teeth in buccal or labial direction
 Group 5 – Traction screws used for closure of extraction
spaces
Screws
Myofunctional Appliances
Classification
1. Tooth borne passive appliances
Tooth borne active appliances
Tissue borne passive appliances

2. Myotonic appliances
Myodynamic appliances

3. Removable functional appliances

Fixed functional appliances

4. Group I, II and III appliances

Inclined plane
Synonyms
 Catalan’s appliance
 Incisor capping appliance

Principle
 Designed to have 450 angulation

Forces the maxillary teeth in cross bite to tip labially

Indications
Maxillary anterior teeth in cross bite

Single tooth crossbite

Palatally displaced maxillary incisors
Segment of upper arch in cross bite

Contraindications
Cross bite due to true manibular prognathism

NOTE- Inclined plane is of value in patients whose

permanent molars have not erupted + loss of
primary molars
Mode of action
 When appliance cemented contact established only at
anterior region

 When patient swallows

No contact posteriorly

All forces transmitted to the region of contact

Teeth guided to erupt in normal position

Duration of treatment
 2-3 weeks, maximum

Disadvantage
 Speech
 Dietary restriction
 Worn more than 6 weeks– anterior open bite
 Frequent re-cementation
Activator
Activator
Synonyms

Biomechanic working retainer

Andersen appliance
Nocturnal airway patency appliance
Norwegian appliance

First removable functional appliance – Viggo

Andersen
Indications
 Class II, Division 1 malocclusion
 Class II, Division 2 malocclusion
 Class III malocclusion
 Class I open bite malocclusion
 Class I deep bite malocclusion
 As a preliminary treatment before major fixed appliance
therapy to improve skeletal jaw relations
 Children with lack of vertical development in lower
facial height
 Activators As Retainers [JCO 1980 Aug(529 - 545)]
Contraindications

 Class I problems of crowded teeth caused by disharmony

between tooth size and jaw size.

 In children
 with excess lower facial height and extreme vertical
mandibular growth.
 whose lower incisors are severely procumbent.
 with nasal stenosis caused by structural problems within
the nose or chronic untreated allergy.

 Limited application in non-growing individuals.

Two principles
 Force application —the source is usually
muscular.

 Force elimination —the dentition is

shielded from normal & abnormal
functional and tissue pressures by pads,
shields, and wire configurations

Mode of action

Myotactic reflex
Modifications of Activator
Herren Shaye activator :
 Herren modified the activator in two ways :
 By over-compensating the ventral position of the mandible
in the construction wax bite.

 By seating the appliance firmly against the maxillary dental

arch by means of clasps (arrowhead, triangular or Jackson's).
The Bow activator of A.M Schwarz :
 Horizontally split activator
 maxillary portion and a mandibular portion connected
together by an elastic bow.
 allows step wise sagittal advancement of the mandible by
adjustment of the bow.
Wunderers modification
 This is an activator modification that is mostly used in
treatment of Class III malocclusion.
 Opening --Anterior screw
Reduced activator or cybernator of Shmuth :

Professor G.P.F. Schmuth.

Resembles a bionator with the acrylic portion of the
activator reduced from the maxillary anterior area
leaving a small flange of acrylic on the palatal slopes.
The two halves may be connected by an omega shaped
palatal wire similar to bionator.
Hyperpropulsor Activator

• Developed - monobloc of Robin

 Consists of a bimaxillary block of acrylic made with the bite

open and the mandible in a forward position.

 Extra oral force used

 Appliance worn only during nights

Cut out or Palate free activator

 Mandibular portion resembles an activator

 Maxillary portion has acrylic covering only the palatal

aspect of the buccal teeth
 Palate remains free of acrylic -- more convenient to wear
the appliance for longer hours.

 TMJ dysfunction cases – best in mandibular positioning

Bimler appliance (Bite former, Bimler stimulator)
 A modification of the activator by H.P. Bimler. There are
three main kinds of Bimler appliance:
 Type A for patients with Class II Division 1 malocclusions,
 Type B for those with Class II Division 2 and
 Type C for patients with a Class III malocclusion.
The Bionator—a Modified Activator
 Developed by Balter
 Termed by Kantorowicz

Advantages over activator

 Considerably less bulky than the activator.
 It lacks the part covering the anterior section of the palate,
which is contiguous to the tongue.
 Children able to speak normally, though the appliance fits
loosely in the mouth.
 The bionator can be worn day and night except at meals.
 An important feature -- its freedom of movement in the
oral cavity.
Indications

1. In a class II, div. 1 malocclusion having

- The dental arches are well aligned originally.
- The skeletal discrepancy is not too severe.
- A labial tipping of the upper incisors is evident.

2. Class III malocclusion

3. Open bite cases

Contraindications

1. The Class II relationship is caused by maxillary

prognathism.

2. A vertical growth pattern is present.

3. Labial tipping of the lower incisors is evident.

BIONATOR TYPES
Standard Appliance.

Reversed bionator.

Open-Bite Appliance.
Twin block
William Clark – 1977

 Goal –maximize the growth response to

functional mandibular protrusion

Principle
 Occlusal inclined plane

 Use of masticatory forces

Indication

 Class II Div 1 with a good arch form

 Lower arch uncrowded
 Upper arch aligned
 Overjet 10-12 mm and a deep bite
 VTO positive
 Patient actively growing– pubertal growth spurt
Standard appliance design

 Midline screw

 Occlusal bite blocks

 Clasps
 Maxilla – molars and premolars
 Mandible – premolars and incisors

 Labial bows
Mechanism of action
TYPES

1. STANDARD

2. SAGITTAL
REVERSE TWIN BLOCK

MAGNETIC TWIN BLOCK

FRANKEL FUNCTION
REGULATOR
DESIGN:
Acrylic + wire components
Base of operation – VESTIBULE
Buccal shields, lower lip pads – restrain musculature
Maxillary wires

Labial bow
Palatal bow
Upper lingual wire
Canine loop
Mandibular wires

Labial support wire

Lingual cross over wire
Lower lingual springs
Types
FR – Ia
 Class I malocclusion with mild to moderate crowding
 Class I deep bite cases

FR – Ib
 Class II, division 1 malocclusion
 Overjet does not exceed 5mm

FR – Ic
 Class II division 1
 Overjet more than 7 mm
FR 2
Class II div 1 and 2

FR 3
Class III

FR 4
Open bite and bimaxillary protrusion

FR 5
• Incorporate headger
MECHANISM OF ACTION:

1. Establishing muscular equlibrium

• Buccal & vestibular pads – relieve buccinator &
orbicularis oris pressure
• In rest & deglutition

• Lingual shields - decrease outward thrust of tongue

2. Enhanced & supplementary widening of upper jaw

 Shields – depth of vestibule ---- create tension ----

periosteal pull ---- apposition of bone
 Stimulate midpalatal suture growth (Stutzman – 1983)
3. Mandibular protrusion:

Normalizing musculature

Not by construction bite

Lip pads - proprioceptive signal for

maintenance of mandibular protrusion

4. Dental effects:

• Anchored to maxilla positively --- Prevents downward &

forward movement of maxillary molars

• Lingual shields ---- decrease outward thrust of tongue ----

allows eruption in more vertical manner

• Buccal shields --- bodily eruption

HERBST APPLIANCE
Indications
 Mandibular retrusion
 Prevention of Bruxism
 Diseases of TMJ

Contraindication
Non growing subject.
Hyperdivergent facial pattern.
Abnormal mid face.
Negative V.T.O.
Diagnostic criteria for selection –

Patients with convex profile ,class II skeletal & class II

dental.

Mainly with retrognathic mandible & orthognathic maxilla

( ANB – 50 )

Positive V.T.O

All first molars & permanent lateral incisors should be fully

erupted.

Lower incisors should be upright or even slightly lingually

positioned.
Design
The appliance can be compared to an artificial joint
working between the maxilla and the mandible.

A bilateral telescope mechanism attached to orthodontic

bands keeps the mandible mechanically in a continuous
anterior jumped position
Each telescopic device consists of
1. A tube ( upper)
2. A plunger ( lower)
3. Two pivots
4. Two screws.

Pivots
Plunger

Tube Screws
 Types of appliances
Bonded Herbst appliance.

Banded Herbst appliance.

Drawback
Banded Herbst appliance- Breakage & loose bands

Bonded Herbst appliance

 difficult to maintain hygiene,
 decalcification & decay are commonly seen .
 can create posterior openbite which needs correction later.
Jasper Jumper
Jasper jumper -

developed & patented by James.J Jasper in 1987

The term jasper jumper --- combining the surname of its

inventor with the functional concept expounded by Kingsley
in late 19th century (jumping the bite).
The Jasper Jumper has 3 particular features –

It leaves standard oral functions such as mastication &

phonetics unimpaired by virtue of its slenderness &
flexibility.

It maintains the sense of touch of opposing tooth.

It cannot be removed readily from the mouth.

Indications for Jasper Jumper

They are basically indicated in skeletal Class II maloccusion

with maxillary excess and mandibular deficiency.

Dental class II malocclusion.

Deep bite with retroclined mandibular incisors.

Contraindications –

Cases predisposed to root resorption.

Dental & skeletal open bites.

Vertical growth pattern.

High mandibular plane angle & increased lower anterior

face height.
Design

The system is composed of two parts

The Force Module and

The Anchor Units.

Force module
It is an open coil,
embedded in soft
synthetic & is attached
through special
connecting pieces.
Other accessories supplied
are –
A ball stop – placed on a
continuous or segmented
orthodontic archwire,
forming a ventral stop for
the appliance.
A ball pin – with which the
appliance is attached to the
upper head gear tube.
Attachment to the main arch wire
Orthopaedic Appliances
Basis for orthopaedic appliances

 Forces applied to the teeth have the potential to radiate

outwards and affect the nearby skeletal structures. For such
skeletal changes to occur, the forces employed should be
over 400 grams.

 Thus the orthopaedic appliances utilize the teeth as

handles to transmit the forces to the adjacent structures.
 Amount of force

 Duration of force
Head gear
Uses

Orthopaedic effect

Anchorage augmentation

Distalization of molars

Molar rotation

Space maintenence
Face mask
Indications

 It can be used in a growing patient having a prognathic mandible and

retrusive maxilla.

 It can be used for bending the condylar neck for stimulating Tmj.

 Selective rearrangement of the of the palatal shelves in cleft patients.

 Correction of postsurgical relapse after osteotomies.

Chin Cup
 A modified RPE appliance in conjunction with a facemask
can be used in growing Class III patients to correct
transverse and sagittal discrepancies.

IJO VOL. 21 NO. 3 FALL 2010

Cephalometric analysis showed a forward and downward movement of the maxilla,
backward and downward rotation of the mandible, proclination of the maxillary
incisors, and slight retroclination of the madibular incisors. The mandibular plane
angle remained stable

The patient’s facial profile improved. The nasolabial angle became more acute and
the upper lip and nose came forward in relation to the chin

IJO VOL. 21 NO. 3 FALL 2010

 In many studies, it was shown that cervical headgear significantly
restrained maxillary forward growth. However, with cervical headgear,
many experienced the undesirable backward rotation of the palatal plane,
the opening of the mandibular plane and maxillary molar extrusion

A maxillary splint design that provided a much larger base area than merely
maxillary first molars for the high-pull headgear force application
 Due to application of extra oral force to the maxilla with
maxillary traction splint appliance there was restriction of
downward and forward growth of the maxilla and maxillary
dentition
 Retraction and intrusion of the maxillary incisors and
retraction and inhibition of vertical development of the
maxillary molars were significant.
 The mandibular plane angle showed a significant reduction
in the treated group as compared to control group.

Orthodontic Waves, March 2010

 Tandam Appliance
 The Tandem Appliance comprises three separate components,
one fixed and two removable.
 The upper section is a fixed Hyrax appliance with buccal arms
soldered for attachment of protraction elastics.
 The lower section is similar to a removable retainer, with
posterior occlusal coverage and buccal headgear tubes
embedded in the lower first-molar regions
 The Tandem Appliance provides a toothborne anchorage system that
combines skeletal and dentoalveolar movement.
 The increased level of patient cooperation with the Tandem
Appliance, combined with the ability to control the vertical
dimension, protract the maxilla, and benefit from the Class III elastic
dentoalveolar effect, makes this appliance extremely valuable in
nonsurgical Class III treatment.
JCO vol 14, issue 6, 2011
CONCLUSION
Catch them young Watch them grow
REFERENCES
 ORTHODONTICS PRINCIPLES AND PRACTICE- GRABER TM

 REMOVABLE ORTHODONTIC APPLIANCES- GRABER NEUMANN

 TEXTBOOK OF PEDIATRIC DENTISTRY- DAMLE

 DENTOFACIAL ORTHOPEDICS WITH FUNCTIONAL APPLIANCES- GRABER

RAKOSI PETROVIC

 REMOVABLE ORTHODONTIC APPLIANCES – M. S. RANI

 ORTHODONTICS THE ART AND SCIENCE- SI BHALAJI

 TEXT BOOK OF PEDODONTICS - SHOBHA TANDON

 INTERNET