Pendulum appliance 2 /certified fixed orthodontic courses by Indian dental academy

PENDULUM APPLIANCE
INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com


JAMES J HILGERS
Editor of JCO and is in private practice of
orthodontics
In 1992 developed the Pendulum appliance
The pendulum appliance is a hybrid that uses a
large Nance acrylic button in the palate for
anchorage, along with .032” TMA springs that
deliver a light continuous force to the upper first
molars. It produces a wide swinging arc of force
from the midline of the palate to the upper
molars and hence the name pendulum
appliance.

The components are
•A recurved molar insertion wire
• A small horizontal loop for adjustment
• A closed helix
• A loop for retention in the acrylic button

PENDULUM SPRINGS


The pendulum springs are made
from .032 TMA wire
The lingual sheaths of the molar
should be .036
The components are
1. Recurved molar insertion wire
2. A small horizontal loop for
adjustment
3. A closed helix
4. A loop for retention in the acrylic
button

The springs are extended as close to
the center of the button
To maximize range of action
To allow easier insertion
To reduce forces to an acceptable range

The springs should be kept as close as
possible distally
To permit acrylic polishing
To minimize irritation during swallowing


ANTERIOR ANCHORAGE
The anterior portion can be retained by
-Banding of the first bicuspids and
soldering a retaining wire
-Bonding occlusal rests on the first
and second premolars.
(James Hilgers recommends
banding)

Nance button
The nance button should be made as
large as possible to prevent tissue
impingement.
It should be 5 mm from the teeth to
avoid the highly vascular cuff of tissue
and to allow adequate hygiene.
The button is made in the office using
light cured acrylic and a triad machine.


PRE ACTIVATION
Preactivation is more efficient than intra
oral activation
The springs are bent parallel to the midline
of the palate(90 degrees)
One third is lost during placement(30
degrees)
Inserted into the lingual sheath using finger
pressure and using a Weingart plier
An elastic O ring is used to hold it in place

REACTIVATION
Patient should be seen every 3
weeks
Reactivation should be done if
needed
The center of the helix ix is held with
a bird beak plier and the spring is
reactivated by pushing the spring
distally towards the midline

CROSS BITE CORRECTION
As the molar is distalized it moves
in an arc towards the midline of
the palate –Cross bite
This can be counteracted by
opening the adjustment loops


STABALIZATION
Full upper fixed appliance is bonded
Insta nance is placed
Omega loops mesial to the molar
holds it in place
A head gear is worn for few months
Passive intrusion arch


INSTA NANCE


PEND X
A pendulum appliance with an
expansion screw
The screw is activated one
quarter turn every three days


EFFECTS ON DENTOFACIAL
COMPLEX
Jose asensi and Varun kalra
April 2001 JCO
Sample of 26 patients and
cephalometrically analysed the post
distalisation changes


CONCLUSION
5.3 mm of distalization of the first molar in
6.5 months at a rate of .8mm per month
Tipping of 2.5 degrees for 1 mm of
distalization
First premolars came forward by 2.2 mm
Reinforcing anchorage is needed
Anterior facial height increased by 2.8 mm
Overbite decreased by 1.8 mm during 6.5
months

CLINICAL AND RADIOLOGICAL
EVALUATION
Byloff and Darendeliler
1996 EJO
13 patients of mean age 11.1
Evaluation was done using Bjorks
superimposition technique
Palatal plane, mandibular plane angle and
SNA
Mean treatment time of 16.6 weeks
Distalization rate .94 mm per month

EVALUATION OF PENDULUM
APPLIANCE
(Joydeep ghosh and Ram nanda -1996)
41 patients were treated with pendulum
appliance
Dental and skeletal changes were
evaluated using cephalometric radiographs
and dental casts
First molar distalized 3.37mm, tipped 8.36
degrees and intruded.1 mm
First premolar moved 2.55mm, tipped 1.29
degrees and extruded1.7mm

Second molars distalized 2.27mm
and tipped 11.99 degrees
Lower anterior facial height increased
by2.79mm
Overbite increased by 1.3mm
Upperlip protruded to .31mm
For every mm of distalization the
premolars moved .75mm mesially

DENTOALVEOLAR CHANGES
WITH PENDULUM APPLIANCE
Timothy and Mc Namara AJO 2000
101 patients were evaluated after the use
of pendulum appliance
Molar distalization was 5.7 mm, tipping was
10.6 degrees
First premolars moved1.8 mm anteriorly
and tipped to 1.5 degrees
Lower anterior facial height increased
to2.2mm
The second molar did not play any role

EFFECT OF ROOT UPRIGHTING
BENDS
Byloff and Darendeliler
After the sagittal correction is over the
uprighting bends are incorporated
The angle between the recurved
arms of the spring and the long arm is
increased 10 to 15 degrees in the
sagittal plane
This causes uprighting of the molars
A smple of 20 patients were treated

CONCLUSION
The first phase took 16.6 weeks
Second phase took 10.9 weeks
The average monthly movement of
the root apex was 1 to 1.5 mm per
month
More anchorage loss was seen at the
incisal end
Second molar position did not
influence the anchorage loss

ANTERIOR ANCHORAGE
CONTROL
Pablo,Guiseppe and Nunzio-JCO
2003
The M pendulum appliance has four
pendulum springs
Increase in overjet is due to
Inadequate vertical control
Molar distalization – for 3mm of
distalization the mandible rotates 1 0
backwards

PENDULUM APPLIANCE WITH
REMOVABLE ARMS
Scuzzo, Kyoto, Stefano JCO 2000
Double over two 7-9mm lengths of .
032 TMA to form bayonet
The bayonet is attached to the
pendulum arm by laser welding or
solderind
The bayonet is embedded in soft
acrylic to form sheaths into which the
removable arms are to be inserted

Dramatic reduction in chair side time
Produces more precise and
predictable results
Less chance of side effects
Ability to replace active arms with
passive stainless steel auxiliaries
after distalization
5mm of distalization can be achieved
in 3-4 months

MODIFIED PENDULUM
(Scuzzo, Kyoto, Flavio 1999 JCO)
The horizontal pendulum loops are inverted for
bodily movement of the molars.
The activation produces distal uprighting of the
roots and the result is a bodily movement
40- 45 degrees or 125 gms of activation is done
The loop activation is done after the spring has
deactivated
It is important to determine the space available for
molar distalization – Rickets pterygoid vertical


FIXED APPLIANCE FOR MAXILLARY
EXPANSION, MOLAR ROTATION, AND
MOLAR DISTALIZATION
David J Snodgrass – JCO 1996
Components
11mm expansion screw
Occlusal rests
0.032 TMA pendulum springs

The expansion screw is soldered to the
mesial of the molar band for rigid fixation
Occlusal rests are placed on all primary
first molars

ACTIVATION
The expansion screw is activated twice a
day for about two weeks
The appliance is left in place for about one
month
The pendulum springs are activated by
cutting the mesial solder joint on the
maxillary molar with no.557 bur
A 7 year old female patient was treated
with appliance. The screw was activated
twice a day for 18 days.The solder joints
were cut. The appliance was removed after
6 months

THE SIMPLIFIED MOLAR
DISTALIZER
(Kevin c Walde –JCO 2003)
Components
-SMD
-Removable springs made of .032 TMA or
Stainless steel
-Occlusal rests
-Nance button
360 degree turn produces .5mm of opening
Four to eight weeks

SMD produces 1mm to 2 mm of molar
movement per month
Easy assembly
Easy activation
Three dimensional molar control
Bodily molar movement
Minimal patient co-operation
Esthetic appearance
Ability to work with second molars

THE MINI DISTALIZING
APPLIANCE
(James J Hilgers and Stephen G Tracey)

Components
Compact RPE
.036 lingual sheaths attached to the
palatal surface of the screw
.032 preactivated pendulum
springs.045 stabalising wire

The RME is activated twice a day
After expansion is complete the
connection with the molar is cut and
the action of the pre activated
pendulum springs start
After the class I molar relation is
achieved the MDA is removed and
passive Utility arch is placed

MAXILLARY MOLAR DISTALIZATION OR
MANDIBULAR ENHANCEMENT
(Donald and Mc Namara Jr and Baccetti –
2003 AJO)
3 groups
Herbst’s appliance (Acrylic splint)
Herbst’s appliance (Stainless steel crown)
Pendulum appliance

Treatment Time
29.5 months
28 months
31.6 months

No statistically significant differences in
mandibular growth in the 3 groups
Skeletal changes accounted for the molar
correction in the Herbst treatment groups than the
pendulum group
Patients in the pendulum group had an increase in
the mandibular plane angle


In Orthodontics as in every other science,
each period reveals truth and steps in progress
which prove the former theories to be wrong, so
it behooves as not to be too dogmatic in our
statements for we are dealing with the unknown,
so at the best our concepts must be largely
hypothetical.
John V Mershon


Pendulum appliance 2 /certified fixed orthodontic courses by Indian dental academy

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