FIXED FUNCTIONAL

APPLIANCE
 CONTENTS
 INTRODUCTION
 CLASSIFICATION
 HERBST APPLIANCE
 RITTO APPLIANCE
 MPA (MANDIBULAR PROTRACTION APPLIANCE)
 MANDIBULAR ANTERIOR REPOSITION APPLIANCE
 JASPER JUMPER
 EURECA SPRING
 POWERSCOPE
 FORSUS FRD
 ADVANSINC
 STUDIES
 CONCLUSION
 INTRODUCTION

 Fixed functional appliance is one that changes in

posture of the mandible, holding it open and forward.
Pressures created by the stretch of the muscles and soft
tissue are transmitted to the dental and skeletal
structures, moving teeth and modified growth.
 CLASSIFICATION

1) Flexible fixed functional appliances.

e.g. Jasper jumper
Churro jumper
2) Rigid fixed functional appliances
e.g. MPA
Herbst appliance
3) Hybrid fixed functional appliances
e.g. Eureka spring.
Forsus FRD
 HERBST APPLIANCE

 The Herbst appliance is the forerunner of

all the fixed functional appliances. It was
introduced by a German professor Emil
Herbst at the international dental
Congress in Berlin in 1905.

 The credit of reintroduction of herbst

appliance goes to Hans Pancherz. Through
an article published in American journal of
orthodontist in 1979.
DESIGN
 The Herbst appliance – generations

 Gen. I – Banded and crown Herbst

 Gen. II – Herbst directly onto archwires
 Gen. III – Cantilever Herbst
 Gen. IV – The Ball joint attachments
The cast splint
herbst
Herbst with stainless steel
crown

Norris M. Langford, (1982)

Bonded herbst Acrylic – Splint Herbst
appliance Appliance

Raymond Howe in (1982)

Mcnamara(1988) and Windmiller(1993)

Removable Plastic Herbst Edgewise by a progressive
Retainer herbst appliance

Raymond Howe (1987) Terry G. Dischinger (1989)

Removable herbst Fixed removable herbst
appliance appliance
 The swedish style integrated
Flip lock herbst
herbst appliance appliance

Paul Haegglund, Staffan Segerdal (1997) Robert a Miller (1996)

 For Partial anchorage, in the maxillary dental arch
band molar and premolar are connected with half round
wire(1.5 x 0.75mm). In mandibular arch premolar bands
connected with half round and round wire(1mm)
touching the lingual surface of anterior teeth.

 For Total anchorage labial arch wire is ligated to

brackets on the first pre-molar incisor and canine in
maxillary arch and in mandibular arch band cemented
in molar and connected with premolar by lingual arch
wire and additionally pre-molar to pre-molar labial
rectangular arch wire.
 INDICATIONS
 The Herbst appliance is indicated in correction of class
2 malocclusion due to retrognathic mandible.
 It can be used as an anterior repositioning splint in
patients having temporo-mandibular joint disorders.
 CONTRAINDICATIONS
 Contraindicated in non growing patients.
 Hyper-divergent facial pattern.
 A patient with negative visual treatment objective
 ADVANTAGES
 It can be used in uncooperative patient as patient
compliance is not required for this appliance.
 The action is continuous for 24 hours of the day
 It can achieve the results in around 6 to 8 months.
 It is advantages in mouth breathers.
 It does not interfere with speech on mastication.
 It can be used successfully in post adolescent patients in
whom very little growth is remaining to work with.
 The procedures such as rapid maxillary expansion, fixed
appliance or headgear can be given with appliance in place.
 DISADVANTAGES
 After active phase treatment with Herbst appliance,
removable functional appliance is required for retention.
 Risk of development of dual bite.
 Masticatory efficiency is reduced.
 High incidence of breakage and loosening of appliance.
 May restrict lateral mandibular movements
 It is expensive
 Plaque accumulation and enamel decalcification occur
especially in the splint type of appliance.
  (1) Bite jumping with the Herbst appliance resulted in Class I occlusal
relationships in all treated cases.


 (2) The improvement in occlusal relationships was about equally a result

of skeletal and dental changes.

 (3) Class II molar correction averaging 6.7 mm. was mainly a result of a
2.2 mm. increase in mandibular length, a 2.8 mm. distal movement of the
maxillary molars, and a 1.0 mm. mesial movement of the mandibular
molars.

 (4) Overjet correction averaging 5.2 mm. was mainly a result of a 2.2 mm.
increase in mandibular length and a 1.8 mm. mesial movement of the
mandibular incisors. 
 (5) Anterior condylar displacement (0.3 mm.), redirection of maxillary
growth (0.4 mm.), and distal movement of the maxillary incisors (0.5
mm.) were of minor importance in the improvement in molar and incisor
relationships seen.

 (6) A direct relationship existed between the amount of bite jumping at

the start of treatment and the treatment effects on the occlusion and on
mandibular growth.
 MANDIBULAR ANTERIOR
REPOSITION APPLIANCE

 The name MARA comes from Mandibular Anterior Repositioning

Appliance. It was developed to overcome the dislike
appearance that patient expressed regarding the herbst
appliance, particularly the bulk in the lower bicuspid area.
 The MARA is attached to stainless steel crowns or rigid bands
on the first molars.
 In addition to the normal rectangular archwire tube, the upper
first molar has a large 0.062 square tube, into which slides an
adjustable 0.06 square “elbow” that hangs vertically.
 The lower first molar has the normal rectangular tube as well
as a 0.59 round wire “arm” projecting buccally from the
mesial.
 Benefits of MARA:
 Compared to headgear: Better appearance, more comfortable, non
compliance, work 24 hours per day, more reliable.

 Compared to removable functional: Less bulky, non-compliance, no

effect on speech, can't get lost, works 24 hours per day, more reliable.

 Compared to molar distalizers: Less bulky, no Nance required, more

hygienic, no effect on speech, more comfortable.

 Compared to interarch springs and herbst appliance: Less visible in

bicuspid area, less cheek irritation, less bulky, no connection between
Jaws, requires fewer braces concurrently, breakage easily repaired.
 The treatment results of the MARA were very similar to those produced
by the Herbst appliance but with less headgear effect on the maxilla and
less mandibular incisor proclination than observed in the Herbst
treatment group.
 MPA

 The mandibular protraction appliance (MPA) has been

developed by Coelho Filho CM for the correction of
class II skeletal deformity. The appliance has been
developed as, other fixed functional appliances like
Herbst and Jasper jumper either need for laboratory
environment or are costly.
MPA I, MPA II, MPA III, MPA IV
 Advantages:
 There is any fabricated at chair side with ordinary inexpensive wires.
 They do not require any special bands, crowns or wire attachments.
 No impressions or wax bite registrations are used and no laboratory
assistance is needed.
 They are easily inserted, adjusted and removed.
 They can be made and installed in about 30 minutes.
 They are much smaller and thus more comfortable and acceptable to
patients than other appliances.
 They permit a greater range of motion and are less restrictive of movements
than other protrusive devices.
 They are easily adaptable for preserving maxillary molar and mandibular
incisor anchorage when minimal movement of these teeth is required.
Bruno D'Aurea FurquimI; José Fernando Castanha Henriques; Effects of mandibular
protraction appliance associated to fixed appliance in adults; Dental Press J. Orthod. vol.18
no.5 Maringá Sept./Oct. 2013.

 Increase in antero-inferior facial height and posterior facial height.

 The dental changes include: extrusion of upper incisors, buccal

inclination, protrusion of lower incisors, mesialization and extrusion of
mandibular molars.

 Regarding the soft tissue component, there was an increase in nasolabial

angle in addition to upper lip retrusion.
 RITTO APPLIANCE

 It can be described as a telescopic system that is both

miniature and versatile. It has been developed with the
goal of creating an efficient appliance of simplified
intraoral application by Dr. A. Koroddi Ritto.
 It is a one piece device with telescopic action. It comes
in a single format which allows it to be used on both
sides. This design helps to reduce the inventory.

 It is made of extremely hard stainless steel. At its widest

point the diameter is 1.7 mm. It is therefore an
extremely small and fine appliance. Loops are
incorporated at the ends as fixing points to support
systems. Fixing accessories consists of a steel ball pin (to
fix the appliance to the upper arch) and a lock
controlled sliding brake which also serves to activate the
appliance on the lower arch. Total length when closed is
25 mm and at maximum opening is 33 mm.
 Advantages
 Unlike other appliances, Ritoo appliance has been
designed in such a way that it does not disengage after
reaching maximum extension. Patient is able to open
mouth around 55 mm.
 Does not require any laboratory procedures.
 Its miniature facilities are easy to adapt with good
aesthetic appearance and no cheek protuberances.
 It is a rigid appliance and does not fracture easily.
 Permits rapid and easy insertion in around 5 minutes
and can be removed in less than half that time.
 Disadvantages:
 For activation of the appliance, it becomes necessary to
remove the fixed form of one of the parts so as to be
able to introduce steel ring onto the lower tube.
 JASPER JUMPER

 The rigid fixed functional appliance especially the

herbst appliance, considered in the previous section,
had one major disadvantage that is its rigidity, which
restricts mandibular lateral movements.
 In an attempt to overcome these problems James
Jasper developed a new pushing device which was
flexible. It was termed as Jasper jumper. It could be
attached between the maxillary and the mandibular
arches to produce both sagittal and intrusive forces
which may be either “headgear like”, “activator like”
forces or combination of both.
 polyurethane

26 to 38mm / 2mm
 Advantages
 Very comfortable for the patient because of the
flexibility of the module.
 Increased freedom for the lateral mandibular
movement.
 The module curves outwards when the teeth are in
occlusion. This decreases the chance of breakage.
 It can be added to the existing appliances virtually at
any point after arch preparation
 Disadvantages
 Unwanted tooth movements.
 Though lesser than herbst appliance, significant
breakage problems do exist especially in canine region
where the debonding of bracket occurs when jumpers
are engaged directly onto the archwires.
 Strict dietary controls are mandatory.
 The patient should be caution repeatedly not to bite
the modules after yawning or excessive wide opening.
David A. Covell Jr, Dennis W. Trammell; A cephalometric
study of Class II Division 1 malocclusions treated with the
Jasper Jumper appliance; Angle ortho d Volume 69, Issue 4
August 1999.
 the Jumpers were in place, maxillary incisors were retroclined and the
molars were moved distally, tipped back, and intruded.

 The mandibular incisors were proclined and intruded, while the molars
were translated mesially, tipped forward, and extruded.

 Skeletal measures showed reduced forward maxillary displacement and

no significant alteration of horizontal mandibular growth.
 EURECA SPRING

 The appliance was introduced by Dr. John Devincenzo

in 1997. This is also of fixed inter-maxillary force
delivery system similar to fixed Herbst appliance, used
in non compliant class II patients.

 The Eureka spring appliance was very effective in

correcting class II malocclusion in non compliant patient
without increasing the vertical dimension.
 Advantages:
 Minimum patient cooperation is required.
 Static acceptability is high.
 Resistant to breakage.
 Minimal tissue irritation.
 Ability to produce rapid tooth movement.
 Functional acceptability.
 Ease of installation.
 Minimal inventory requirement.
 Optimal direction of force.
 Low cost: cost is less than the Herbst appliance.
 Promotion of good oral hygiene.
 Disadvantages:
 Tissue irritation.
 Difficulty to clean attachment area
Ernest L. Stromeyer, Joseph M. Caruso; A Cephalometric
Study of the Class II Correction Effects of the Eureka
Spring; Angle Orthod 2002;72:203–210.

 The ES treatment resulted in no change in the vertical dimension, as

evidenced by neither increased anterior face height nor increased
mandibular plane angle.

 This finding suggests that the ES has clear advantages over Class II elastics
and cervical extraoral anchorage in dolichocephalic facial forms.
 FORSUS FRD

 Forsus was given by American orthodontist Bill Vogt of

Philadelphia.

 This is an innovative telescopic appliance with coil spring in

its exterior part. This feature makes it resemble some flexible
functional appliances. It comprises a 0.5 x 3.0 mm spring bar
(45% nickle, 55% titanium) with a transparent plastic coating.

 In comparison with other FFA its advantage lies in coil spring

resistance to breakage. The coil spring is applied by sliding on
a rigid surface avoiding in this way any angulations at the
fixing points. It is sold in kits that include different length
sizes for left and right side.
split crimp
Giorgio Cacciatore ; Luis Tomas Huanca Ghislanzoni; 
Treatment and posttreatment effects induced by the Forsus
appliance: A controlled clinical study; Angle
Orthod. 2014;84:1010–1017.

 The FRD protocol revealed to be effective in correcting Class II

malocclusion mainly at the dentoalveolar level.

 At the end of the treatment period, significant improvements in

dentoalveolar sagittal intermaxillary relationships were found, together
with a slight ‘‘headgear effect’’ on the maxilla.

 At the end of the posttreatment period, only the dentoalveolar changes

remained stable, while no significant sagittal or vertical skeletal change
was present
 POWERSCOPE

 PowerScope is the latest innovation in

Class II correction which is a direct
derivative of the Herbst Type II appliance.
Dr. Andy Hayes worked in conjunction
with American Orthodontics to develop
PowerScope. This appliance addresses
critical needs of the orthodontist
including the patient comfort and
acceptance, extensive range of motion,
simple installation, and much more.
 PowerScope is delivered as a one size fits all appliances
preassembled with attachment nuts for quick and easy chairside
application. The appliance allows intermaxillary wire-to-wire
installation using a nut with hexagonal screw, ball and socket joint
to maximize the lateral movements improving patient comfort.

 The appliance consists of a telescopic mechanism consisting of

inner shaft/push rod, middle and outer tubing. Between middle
tubing and outer tubing, there is a nickel-titanium (NiTi) spring
delivering constant force of 260gm

 This appliance delivers good patient comfort, eliminates the need

for headgear tubes or special band assemblies, and can be used
with either banded or bonded molar tubes.
 Advantages:
 1. Fixed one‑piece appliance available in one size suiting
 all Class II patients.
 2. Require no laboratory setup.
 3. Quick and easy wire‑to‑wire installation.
 4. Compliance is good.
 5. Internal NiTi spring delivers 260 g of force for continuous activation during treatment.
 6. No headgear tube or special band assemblies required.
 7. Can be used with banded or bonded molar tube.
 8. No bond failure of canine bracket or buccal tube.
 9. Low profile and less bulky for more esthetic facial appearance.
 10. Smooth, rounded patient friendly design for better patient comfort.
 11. Easy to clean – better oral hygiene.
 12. Ball and socket joint allowing maximum lateral movement.
 13. Telescopic device that does not displace or disengage during treatment.
Aditi Malhotra, Kehar Negi, Jai Kaundal, Nishant Negi; Cephalometric
evaluation of dentoskeletal and soft-tissue changes with powerscope Class II
corrector; Journal of Indian Orthodontic Society(Vol. 52, Issue 3..

 Maxillomandibular relationship improved with significant lengthening of the

mandible.

 There was retroclination of maxillary incisors, proclination of mandibular

incisors, extrusion, and sagittal displacement of mandibular molars and
clockwise rotation of occlusal plane.
 ADVANSYNC

 It was developed by TERRY DISCHINGER

 It has a molar to molar fixed functional assembly i.e.

upper first molar to lower first molar on each side.
Hence the name of the appliance reflects that mandible
can be postured forward synchronously with the start of
all the other fixed appliance tooth movements.

 This class II corrector has no laboratory work. The

attachment of the appliance is similar to a hybrid
between a molar band and a preformed crown
 Advantages:
 1. It is quick and easy to place.
 2. The appliance can be placed on its own or with a partial or full fixed
appliance. This versatility enables placement in the mixed and
permanent dentitions.
 3. Reduces the need for two phase treatment.
 4. Complete class II treatment within six to nine months.
 5. Provides constant activation and eliminates the need for patient
compliance.
 6. Allows freedom of mechanics mesial to molar crowns.
 7. Provides maximum comfort and range of motion.
 8. No TPA or lingual arch needed.
 9. Built-in activation-no need to change the arms for final activation.
Thikriat S. Al-Jewaira, Charles B. Preston; A comparison of the MARA and the
AdvanSync functional appliances in the treatment of Class II malocclusion;
Angle Orthod. 2012;82:907– 914.

 The MARA and the AdvanSync resulted in normalization of the Class II

malocclusion. The AdvanSync showed more headgear effect but less
mandibular length enhancement than MARA did. Both appliances showed
similar dentoalveolar changes.
 (Am J Orthod Dentofacial Orthop 2006;129:599.e1-599.e12)

The Herbst appliance had the highest coefficient of efficiency (0.28 mm per month)
followed by the Twin-block (0.23 mm per month). Both the bionator and the activator
had intermediate scores of efficiency (0.17 and 0.12 mm per month, respectively).
The Fränkel appliance had the least efficiency (0.09 mm per month).
(SeminOrthod2014;20:324–338.)

The Removable functional appliances(RFAs) did not demonstrate any clinically significant
skeletal changes ; however , clinically significant dental changes included distal
movement of upper molars and upper incisors ,along with vertical movement of lower
molars.The fixed functional appliances(FFAs) showed no significant maxillary skeletal
effects, but in contrast , an increase in Co–Gn ( mandibular length) and N perpendicular
to Pog was observed. The dental changes noted were distal movement of maxillary molars
and incisors, accompanied by lower incisor proclination.
(Am J Orthod Dentofacial Orthop 2011;140:210-23)
 (Am J Orthod Dentofacial Orthop 2011;140:210-23)

Headgear treatment in growing subjects with Class II malocclusion is effective

in the short term to restrict sagittal maxillary growth. The use of headgear produces a
significant reduction of overjet and thus may contribute in reducing the risk of dental
trauma in growing patients.
European Journal of Orthodontics, 2017, 1–7

• Treatment with removable functional appliances at puberty induced a significant

long-term enhancement of mandibular growth with an increase in mandibular ramus
height and protrusion of the chin.
• When treatment was performed before puberty, Class II correction was mostly
confined to the dentoalveolar level, with significant improvements of both overjet and
molar relationships..
 (Am J Orthod Dentofacial Orthop 2007;132:499-503)

Treatment effects differed between the groups, with usually more favorable effects in
the Herbst group. However, during the follow-up period, many of the changes were
reversed. During the total observation period, maxillary prognathism and lower
anterior facial height increased more in the Begg group than in the Herbst group. Most
of these differences were not sustained over the longer term.

(Am J Orthod Dentofacial Orthop 2013;143:383-92)

Class II correction with Class II elastics is primarily dentoalveolar

The results of FFA are similar in long term to class II elastics.
Journal of Orthodontic Science - Volume 6, Issue 2, April-June 2017

•Significant increase in the nasopharynx and oropharynx was observed with Activator
Significant increase in the nasopharynx and hypopharynx was observed with Bionator.

Significant increase in the oropharynx and hypopharynx was observed with Twin
Block.
Significant increase
(Amwas observed
J Orthod only in the
Dentofacial hypopharynx
Orthop with Frankel II
2016;150:979-88)
Decrease/ insignificant change was observed with FMA, MPA IV, and Herbst
appliances.

AdvanSync produced its effects through maxillary skeletal growth restriction and
mandibular dentoalveolar changes.
Class II elastics worked primarily through dentoalveolar changes in both the maxilla
and the mandible.
Journal of Contemporary Orthodontics, February 2018, Vol 2, Issue 1, (page 18-23)

Association of TADs with fixed functional appliance can reduce undesirable

proclination of lower incisors and enhance skeletal response. Upper and lower
pharyngeal airway dimensions exhibit changes, with lower airway showing highly
significant changes.

Angle Orthodontist, Vol 76, No 6, 2006

A Class II patient at the peak in skeletal maturation (CS 3) with a pretreatment

Co-Go-Me smaller than 125.5 is expected to respond favorably to treatment including
FJO.
 J Orofac Orthop 2011; 72:434-445

The anterior temporalis and masseter muscles clearly responded to appliance therapy
The neuromuscular adaptation documented after 6 months of treatment remained
stable over a 24-month observation period.

Int J Pharm Bio Sci 2015 July; 6(3): (B) 1066 - 1075

• In comparison with FRD- Twin-block produced greater mandibular advancement

whereas FRD caused lower incisor proclination.
• In comparison with Herbst appliance- Twin-block showed only skeletal improvement
but Herbst appliance showed both dental and skeletal improvement . Herbst
appliance was more effective in reducing overjet. In cases with mandibular
retrognathy TB is the appliance of choice but in cases with maxillary prognathism
followed by the mandibular retrognathy Herbst appliance is the better choice.
 Dental Press J Orthod. 2018 Mar-Apr;23(2):87-109

1. Rigid FFA provide better skeletal results than flexible and hybrid ones.
2. Flexible and hybrid appliances have similar effects to those produced by Class II
elastics. They ultimately correct Class II with dentoalveolar changes.
3. From a biomechanical standpoint, FFA are more recommended to treat Class II in
dolichofacial patients, in comparison to Class II elastics.
 CONCLUSION

 There are some disadvantages in all the appliances, but

by considering their modified designs and better
compliance to the patient, with the help of newer
technology we need to combine their advantages to
eliminate theirs drawbacks and make further beneficial
designs which can give us better results
THANK
YOU