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2. IntroductionIntroduction
Treatment of class II has a controversialTreatment of class II has a controversial
historyhistory
Americans – head gears and class IIAmericans – head gears and class II
elasticselastics
Europe – popularized – functionalEurope – popularized – functional
appliancesappliances
Surgical options – given new diemensionsSurgical options – given new diemensions
to the treatment of adult class IIto the treatment of adult class II
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3. CLASSIFICATION:CLASSIFICATION:
According to Edward H. AngleAccording to Edward H. Angle
CLASS II
Class II div 1
(distoocclusion with
labioversion of
upper incisors)
Class II div 2
(disto occlusion with
llinguo
version of
maxillary incisors)
Class II div1 subdivision
classII div2 subdivision
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4. EXTRA ORAL FEATURESEXTRA ORAL FEATURES
CONVEX PROFILECONVEX PROFILE
INCOMPETENT LIPSINCOMPETENT LIPS
LOWER FACIAL HEIGHT,LOWER FACIAL HEIGHT,
OR AVGOR AVG
DEEP MENTO LABIALDEEP MENTO LABIAL
SULCUSSULCUS
ABNORMALABNORMAL
MUSCULATUREMUSCULATURE
• STRAIGHT TO
CONVEX PROFILE
• COMPETENT LIPS
• LOWER FACIAL
HEIGHT -
DECREASED
CLASS II DIV 1 CLASS II DIV 2
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5. INTRA ORAL FEATURESINTRA ORAL FEATURES
TAPERED ARCHTAPERED ARCH
UPPER ANTERIORSUPPER ANTERIORS
PROCLINEDPROCLINED
OVER BITE –OVER BITE –
VARIABLEVARIABLE
INCREASEDINCREASED
OVERJETOVERJET
• SQUARE ARCH
• CENTRALS
RETOCLINED,
LATERALS ARE
PROCLINED
• DEEP OVER BITE
• NORMAL TO MILD
INCREASE IN
OVERJET
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7. Class II, subdivisionClass II, subdivision
When a class II molar relation exists on oneWhen a class II molar relation exists on one
side and a class I relation on the other, it isside and a class I relation on the other, it is
referred to as class II subdivision.referred to as class II subdivision.
Based on whether it is a division 1 or divisionBased on whether it is a division 1 or division
2 it can be called a class II, division 1,2 it can be called a class II, division 1,
subdivision or a class II, division 2,subdivision or a class II, division 2,
subdivision.subdivision.
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8. ETIOLOGY:ETIOLOGY:
It is important to distinguish class II malocclusions thatIt is important to distinguish class II malocclusions that
are primarily of genetic origin from those ofare primarily of genetic origin from those of
primarily environmental when choosing theprimarily environmental when choosing the
appropriate treatment andappropriate treatment and retention.retention.
A.A. Genetic causesGenetic causes:: HERIDITYHERIDITY
B.B. ..Environmental causes:Environmental causes:
1.1.HabitsHabits::
2. Trauma-T M J Ankylosis2. Trauma-T M J Ankylosis
Forceps deliveryForceps delivery
3.Early Exfoliation of primary molars.3.Early Exfoliation of primary molars.
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10. TREATMENT PLANTREATMENT PLAN
SKELETAL CLASS II DENTAL CLASS II
MAXILLARY EXCESS
MANDIBULAR
DEFICIENCY
COMBINATION
MAXILLARY MOLARS
MOVED FORWARD
MESIAL IN ROTATION OF
MAXILLARY MOLARS
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12. PRIMARY DENTITION(3-6Yrs)PRIMARY DENTITION(3-6Yrs)
A.Space maintenance in primary molarA.Space maintenance in primary molar
area.area.
B.Incisor protrusion-Habit breakingB.Incisor protrusion-Habit breaking
appliances are given.appliances are given.
C. Antero posterior discrepancy- A distalC. Antero posterior discrepancy- A distal
step has to be identified at this stage andstep has to be identified at this stage and
growth modification is to be attemptedgrowth modification is to be attempted
only in severe cases as continuing growthonly in severe cases as continuing growth
complicates this problem.complicates this problem.
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14. Maxillary prognathismMaxillary prognathism
Head gears
The type of head gear is chosen according toThe type of head gear is chosen according to
the growth patternthe growth pattern
Consists of the face bow, force module and theConsists of the face bow, force module and the
strapstrap
The strap will differ according to the growthThe strap will differ according to the growth
patternpattern
The angulation and length of the face bow canThe angulation and length of the face bow can
be changed to achieve the desired moments andbe changed to achieve the desired moments and
force required for a particular clinical situationforce required for a particular clinical situation
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15. CERVICAL PULL HEADCERVICAL PULL HEAD
GEARGEAR
Indicated in patients withIndicated in patients with
decreased verticaldecreased vertical
dimension.dimension.
Outer bow lies above theOuter bow lies above the
plane of occlusion toplane of occlusion to
direct force throughdirect force through
centre of resistance andcentre of resistance and
prevent distal tipping ofprevent distal tipping of
the molars.the molars.
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16. High pull head gearHigh pull head gear
Indicated in patients with increasedIndicated in patients with increased
vertical dimension.vertical dimension.
Face bow is anchored to an occipitalFace bow is anchored to an occipital
anchoring unit to produce a verticallyanchoring unit to produce a vertically
directing force.directing force.
High pull head gear- can redirect theHigh pull head gear- can redirect the
vertical diemension of the maxilla thusvertical diemension of the maxilla thus
allowing the auto rotation of the mandibleallowing the auto rotation of the mandiblewww.indiandentalacademy.comwww.indiandentalacademy.com
17. Force magnitude for HG:Force magnitude for HG:
Recommended force values per sideRecommended force values per side
Full permanent dentition – 400-600 gmsFull permanent dentition – 400-600 gms
Early mixed dentition – 150-250 gmsEarly mixed dentition – 150-250 gms
Late mixed dentition – 300-400 gmsLate mixed dentition – 300-400 gms
Retention in permanent dentition – 150-Retention in permanent dentition – 150-
400 gms.400 gms. www.indiandentalacademy.comwww.indiandentalacademy.com
18. Head gear are tooth borne Attached to the molar tube
Intermittent forces
Minimizes tooth movement
Provide skeletal change
Less damaging to the tissue
Due to the rest period
Duration:Duration: Graber, forces of 12-16 hourGraber, forces of 12-16 hour
durationduration
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19. Mandibular deficiencyMandibular deficiency
Functional appliances is the choice ofFunctional appliances is the choice of
treatment for mandibular deficiency intreatment for mandibular deficiency in
growing children.growing children.
Criteria for case selection are:Criteria for case selection are:
Individuals with growth potentialIndividuals with growth potential
Retrognathic mandibleRetrognathic mandible
Deep biteDeep bite
Low mandibular plane angleLow mandibular plane angle
Favourable V T OFavourable V T O
Upright lower incisorUpright lower incisorwww.indiandentalacademy.comwww.indiandentalacademy.com
21. TREATMENT FOR HORIZONTALTREATMENT FOR HORIZONTAL
GROWTH PATTERNGROWTH PATTERN
Short face (skeletal deep bite) class IIShort face (skeletal deep bite) class II
Obtain differential growth of the jaws such that theObtain differential growth of the jaws such that the
mandible catches up with the maxilla and themandible catches up with the maxilla and the
skeletal problem improves or disappears.skeletal problem improves or disappears.
Allow more eruption of the lower than the upper teethAllow more eruption of the lower than the upper teeth
so that the occlusal plane rotates up posteriorly, inso that the occlusal plane rotates up posteriorly, in
the direction that facilitates Class II correction, deepthe direction that facilitates Class II correction, deep
bite and increase lower facial heightbite and increase lower facial height
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22. Treatment optionsTreatment options
Functional jaw orthopedicsFunctional jaw orthopedics
Functional appliance therapy.Functional appliance therapy.
Cervical headgear tends to open the biteCervical headgear tends to open the bite
anteriorly. It differentially erupts the upperanteriorly. It differentially erupts the upper
rather than the lower molars and does notrather than the lower molars and does not
produce the desired change in orientationproduce the desired change in orientation
of the occlusal plane.of the occlusal plane.
Functional appliances is most useful inFunctional appliances is most useful in
the treatment of short face class IIthe treatment of short face class II
treatmenttreatment www.indiandentalacademy.comwww.indiandentalacademy.com
23. Class II children with normal facialClass II children with normal facial
height.height.
May have anterior deep bite because ofMay have anterior deep bite because of
excessive eruption of the lower incisors.excessive eruption of the lower incisors.
Current guidelines for treatment are:Current guidelines for treatment are:
Functional jaw orthopaedics.Functional jaw orthopaedics.
Functional appliance therapy.Functional appliance therapy.
Straight-pull headgear is preferred. This reducesStraight-pull headgear is preferred. This reduces
elongation of maxillary molars and better controlelongation of maxillary molars and better control
the inclination of the mandibular planethe inclination of the mandibular planewww.indiandentalacademy.comwww.indiandentalacademy.com
24. The objective of treatment are:The objective of treatment are:
1.1. Restriction of the forward maxillary growthRestriction of the forward maxillary growth
2.2. Inhibition of the mesial and verticalInhibition of the mesial and vertical
displacement of the maxillary teeth.displacement of the maxillary teeth.
3.3. Improvement of the mandibular horizontalImprovement of the mandibular horizontal
growth.growth.
4.4. Condylar and glenoid fossa remodelling.Condylar and glenoid fossa remodelling.
5.5. Improvement in muscle pattern.Improvement in muscle pattern.
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25. Treatment optionsTreatment options
Functional jaw orthopaedicsFunctional jaw orthopaedics
Functional appliance therapy.Functional appliance therapy.
High pull head gear to a maxillary splintHigh pull head gear to a maxillary splint
is used as it controls the eruption of theis used as it controls the eruption of the
teeth.teeth.
Eruption of lower teeth is controlledEruption of lower teeth is controlled
most readily with interocclusal bite blocks.most readily with interocclusal bite blocks.
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26. Vertically-directed extraoral force to theVertically-directed extraoral force to the
functional appliance gives better control offunctional appliance gives better control of
maxillary growth, so the most effectivemaxillary growth, so the most effective
treatment is a combination of a functionaltreatment is a combination of a functional
appliance with bite blocks and high-pullappliance with bite blocks and high-pull
headgear.headgear.
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27. FUNCTIONAL APPLIANCESFUNCTIONAL APPLIANCES
““A functional appliance harnesses naturalA functional appliance harnesses natural
forces which it transmits to the teeth andforces which it transmits to the teeth and
alveolar bone in a pre determined direction”.alveolar bone in a pre determined direction”.
(White, Gardiner, Leighton)(White, Gardiner, Leighton)
..
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29. Long face(skeletal open bite)Long face(skeletal open bite)
Characterized by excessive anterior facialCharacterized by excessive anterior facial
height.height.
Major diagnostic criteria:Major diagnostic criteria:
Short mandibular ramus.Short mandibular ramus.
Rotation of palatal plane down posteriorlyRotation of palatal plane down posteriorly
Typical growth pattern showsTypical growth pattern shows
Vertical growth of maxilla often posteriorly thanVertical growth of maxilla often posteriorly than
anteriorly.anteriorly.
Downward-Backward rotation of the mandibleDownward-Backward rotation of the mandible
and an excessive eruption of maxillary andand an excessive eruption of maxillary and
mandibular teeth.mandibular teeth.
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30. REMOVABLE FUNCTIONALREMOVABLE FUNCTIONAL
Removable Functional appliancesRemovable Functional appliances
used in the treatment of class IIused in the treatment of class II
malocclusion.malocclusion.
ACTIVATORACTIVATOR
BIONATORBIONATOR
FRANKEL APPLIANCEFRANKEL APPLIANCE
TWIN BLOCKTWIN BLOCK
THE MODIFIED BASS APPLIANCETHE MODIFIED BASS APPLIANCE
MANDIBULAR GROWTH APPLIANCEMANDIBULAR GROWTH APPLIANCE
MAGNETIC FUNCTIONAL SYSTEMMAGNETIC FUNCTIONAL SYSTEM
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31. ACTIVATORACTIVATOR
Introduced by Viggo Andreson in theIntroduced by Viggo Andreson in the
year 1908.year 1908.
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32. Mode of action of activator: (Mode of action of activator: ( Aus-Aus-
Ortho-1985-March Graeme. L. Roberts)Ortho-1985-March Graeme. L. Roberts)
Re-education of musculature.Re-education of musculature.
Lateral pterygoid muscle stimulationLateral pterygoid muscle stimulation
(LPM).(LPM).
Unloading of the mandibular condyle.Unloading of the mandibular condyle.
Transduction of viscoelastic force.Transduction of viscoelastic force.
Differential eruptions.Differential eruptions.
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33. Antero-posterior effects ofAntero-posterior effects of
activator:activator:
A forward displacement of the lowerA forward displacement of the lower
arch.arch.
A distal movement of maxillary arch.A distal movement of maxillary arch.
An inhibition of the forward growth of theAn inhibition of the forward growth of the
maxilla.maxilla.
A stimulation of condylar growth.A stimulation of condylar growth.
A remodelling of the mandibular fossa.A remodelling of the mandibular fossa.
An elimination of interferences.An elimination of interferences.
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34. The vertical effects:The vertical effects:
Successful overbite reduction found to beSuccessful overbite reduction found to be
accompanied by:accompanied by:
Inhibition of lower incisor eruption.Inhibition of lower incisor eruption.
Facilitation molar eruption.Facilitation molar eruption.
Encouragement of forward mandibularEncouragement of forward mandibular
rotation.rotation.
An increase in lower face height.An increase in lower face height.
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35. Treatment Effect Of Mandibular ProtrusiveTreatment Effect Of Mandibular Protrusive
Appliance On The Glenoid Fossa For Class IIAppliance On The Glenoid Fossa For Class II
Correction.Correction.
Katsavrias et alKatsavrias et al
-A. O. 2004-A. O. 2004
The glenoid fossa does not change in morphology
radiographically.
Glenoid fossa does not appear radiographically to
contribute positive growth modifications to the class
II correction by active bone modeling.www.indiandentalacademy.comwww.indiandentalacademy.com
36. Combination Headgear-ActivatorCombination Headgear-Activator
(JCO 1984 DR. HERMAN VAN BE)(JCO 1984 DR. HERMAN VAN BE)
The headgear-activator has the followingThe headgear-activator has the following
modes of action:modes of action:
1. Intrusion and retraction of upper front1. Intrusion and retraction of upper front
teethteeth
2. Distalization of upper molars2. Distalization of upper molars
3. Maxilla retraction3. Maxilla retraction
4. Mandibular growth stimulation,4. Mandibular growth stimulation,
especially in the brachyfacial groupespecially in the brachyfacial group
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37. 5. Opening of the facial axis in the5. Opening of the facial axis in the
brachyfacial groupbrachyfacial group
6. Maintenance of the facial axis in the6. Maintenance of the facial axis in the
dolichofacial groupdolichofacial group
7. Minor, if any, tilting of lower incisors7. Minor, if any, tilting of lower incisors
8. Stopping lower incisor eruption8. Stopping lower incisor eruption
9. Stopping the descent of the palate9. Stopping the descent of the palate
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38. Stability of class II div 1 treatment with the head gear-Stability of class II div 1 treatment with the head gear-
activator combinationactivator combination
Guilherme and associatesGuilherme and associates
A. O. 2004A. O. 2004
Results of their studyResults of their study
Sagittal position of both the maxilla andSagittal position of both the maxilla and
the mandible was stable in the long term.the mandible was stable in the long term.
A slight relapse of the maxillo-mandibularA slight relapse of the maxillo-mandibular
relation correction occurred, probablyrelation correction occurred, probably
because the maxilla resumed its normalbecause the maxilla resumed its normal
development and the mandible showed adevelopment and the mandible showed a
growth rate significantly smaller.growth rate significantly smaller.
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39. BIONATOR: Introduced byBIONATOR: Introduced by
Baltors in 1960Baltors in 1960
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40. PrinciplesPrinciples
The essential part of Balters concept is the roleThe essential part of Balters concept is the role
of theof the tonguetongue..
““The equilibrium between the tongue andThe equilibrium between the tongue and
cheeks, especially between the tongue and lipscheeks, especially between the tongue and lips
in the height, breadth and depth in an oralin the height, breadth and depth in an oral
space of maximum size and optimal limits,space of maximum size and optimal limits,
providing functional space for the tongue ,isproviding functional space for the tongue ,is
essential for the natural health of the dentalessential for the natural health of the dental
arches and their relation to each other”arches and their relation to each other”
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41. Aims of RxAims of Rx ::
1.1. Accomplish lip closure and establishAccomplish lip closure and establish
contact b/w back of the tongue and softcontact b/w back of the tongue and soft
palatepalate
2.2. Enlarge oral spaceEnlarge oral space
3.3. Incisors in edge to edgeIncisors in edge to edge
4.4. Elongation of the mandibleElongation of the mandible
5.5. Leading to an improved relationship b/wLeading to an improved relationship b/w
the jaws, tongue, dentition and soft tissuesthe jaws, tongue, dentition and soft tissues
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42. Skeletal, Dentoalveolar and Soft tissuesSkeletal, Dentoalveolar and Soft tissues
changes with the standard bionatorchanges with the standard bionator.(Varun.(Varun
Kalra AJO-95)Kalra AJO-95)
Skeletal changes-Skeletal changes-
Mandible-pt.B is moved forwardMandible-pt.B is moved forward
-length of mandible (Ar-Go) is increased-length of mandible (Ar-Go) is increased
Dentition-Dentition-
Overjet and overbite is decreasedOverjet and overbite is decreased
Soft tissuesSoft tissues--
Facial convexity is decreasedFacial convexity is decreased
Uncurling of the lower lip.Uncurling of the lower lip.www.indiandentalacademy.comwww.indiandentalacademy.com
43. Changes in soft tissue profile following treatmentChanges in soft tissue profile following treatment
with bionatorwith bionator
A.O. 1995A.O. 1995
Decreased skeletal convexity;Decreased skeletal convexity;
Increased anterior and posterior faceIncreased anterior and posterior face
heights;heights;
Reduced overjet and overbite;Reduced overjet and overbite;
Decreased facial convexity;Decreased facial convexity;
Uncurling and increase in length of theUncurling and increase in length of the
lower lip;lower lip;
Minimal effect on the upper lip.Minimal effect on the upper lip.www.indiandentalacademy.comwww.indiandentalacademy.com
44. FRANKEL APPLIANCEFRANKEL APPLIANCE
Introduced by FRANKEL in the yearIntroduced by FRANKEL in the year
19661966
PhilosophyPhilosophy
Vestibular arena of operations.Vestibular arena of operations.
Sagittal correction via tooth borneSagittal correction via tooth borne
maxillary anchorage.maxillary anchorage.
Minimal maxillary basal effect.Minimal maxillary basal effect.
Lip pads, buccal shields and periostealLip pads, buccal shields and periosteal
pull.pull. www.indiandentalacademy.comwww.indiandentalacademy.com
45. Mechanism of action:Mechanism of action:
This appliance is used as oral gymnasticThis appliance is used as oral gymnastic
appliance to help in overcoming abnormalappliance to help in overcoming abnormal
perioral muscle activity and rehabilitates theperioral muscle activity and rehabilitates the
muscles and to establish proper lip seal.muscles and to establish proper lip seal.
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46. TWIN BLOCK:TWIN BLOCK:
Introduced by William Clark(1977)Introduced by William Clark(1977)
Mechanism of actionMechanism of action ::
Forces of occlusion are used as functionalForces of occlusion are used as functional
mechanism to correct malocclusion.mechanism to correct malocclusion.
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47. MANDIBULAR GROWTH ADVANCERMANDIBULAR GROWTH ADVANCER ::
INTRODUCED BY YOKOTA IN THE YEARINTRODUCED BY YOKOTA IN THE YEAR
1993.1993.
It advances the mandibleIt advances the mandible
progressively with a splint, with theprogressively with a splint, with the
objective of remodelling the condyle andobjective of remodelling the condyle and
the glenoid fossa in the TMJ.the glenoid fossa in the TMJ.
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48. Advantage:Advantage:
Since this appliance is simple, it canSince this appliance is simple, it can
be used concomitantly with a fixedbe used concomitantly with a fixed
appliance. Thus tooth irregularity can beappliance. Thus tooth irregularity can be
corrected simultaneously with thecorrected simultaneously with the
correction of the skeletal discrepancy.correction of the skeletal discrepancy.
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49. Permanent dentitionPermanent dentition
FFA comes to play in adolescent.FFA comes to play in adolescent.
A complete FFA cannot be used in theA complete FFA cannot be used in the
mixed dentition period.mixed dentition period.
In permanent dentition, there is no reasonIn permanent dentition, there is no reason
to delay aligning the teeth , and a growthto delay aligning the teeth , and a growth
modification that makes this difficult ormodification that makes this difficult or
impossible is s disadvantage.impossible is s disadvantage.
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50. Growth modification with FIXEDGrowth modification with FIXED
functional appliancesfunctional appliances
In adolescent, often a fixed functionalIn adolescent, often a fixed functional
appliance that allows brackets on the incisorappliance that allows brackets on the incisor
teeth is the best choice.teeth is the best choice.
Fixed functional appliances can be classified asFixed functional appliances can be classified as
eithereither
Flexible (Flexible Fixed Functional Appliance)Flexible (Flexible Fixed Functional Appliance)
Rigid (Rigid Fixed Functional Appliance -Rigid (Rigid Fixed Functional Appliance -
RFFA).RFFA).
HYBRID APPLAINCESHYBRID APPLAINCES
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51. Flexible fixed functional appliancesFlexible fixed functional appliances
Jasper JumperJasper Jumper
Amoric torsion coilsAmoric torsion coils
Adjustable bite correctorAdjustable bite corrector
Scandee tubular jumper.Scandee tubular jumper.
Klapper super spring IIKlapper super spring II
Bite fixerBite fixer
Churro jumperChurro jumper
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52. JASPER JUMPERJASPER JUMPER
Advantages:
1.Ease of insertion
and activation.
2.Generation of the
intrusive forces on
molars and incisors
Introduced by
J.J. Jasper
1980
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53. Disadvantages include:Disadvantages include:
Large inventory five sizes of left and right.Large inventory five sizes of left and right.
Breakage and a lack of force when theBreakage and a lack of force when the
mouth is held open slightly.mouth is held open slightly.
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54. THE AMORIC TORSION COILSTHE AMORIC TORSION COILS
Introduced by AMORIC. M IN 1994Introduced by AMORIC. M IN 1994
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55. ADJUSTABLE BITEADJUSTABLE BITE
CORRECTORCORRECTOR
Introduced by RICHARD P. WEST 1995Introduced by RICHARD P. WEST 1995
This is an appliance which is assembledThis is an appliance which is assembled
by the orthodontist as it is composed ofby the orthodontist as it is composed of
various pieces – caps, closed coil springs,various pieces – caps, closed coil springs,
nickel titanium wire.nickel titanium wire.
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57. Klapper SUPER Spring IIKlapper SUPER Spring II
Introduced by Lewis Klapper, 1999Introduced by Lewis Klapper, 1999
The SUPER spring II has proven to be excellentThe SUPER spring II has proven to be excellent
for TMD patients who require orthodonticfor TMD patients who require orthodontic
treatment after splint therapytreatment after splint therapy..
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58. BITE FIXERBITE FIXER
(Ormco 1717 West Collins Avenue, Orange,(Ormco 1717 West Collins Avenue, Orange,
CA 92867)CA 92867)
This is a new inter maxillary spring coil.This is a new inter maxillary spring coil.
The spring is attached and crimped to theThe spring is attached and crimped to the
end fitting to prevent breakage betweenend fitting to prevent breakage between
the spring and the end fitting.the spring and the end fitting.
Polyurethane tubing is inside the spring toPolyurethane tubing is inside the spring to
prevent it from becoming a food trap .prevent it from becoming a food trap .
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59. CHURRO JUMPERCHURRO JUMPER
Introduced by Castañon R. et al., 1998Introduced by Castañon R. et al., 1998
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60. Rigid Fixed Functional Appliances.Rigid Fixed Functional Appliances.
1.Herbst appliance1.Herbst appliance
2. Cantilever bite jumper2. Cantilever bite jumper
3. Malu herbst appliance3. Malu herbst appliance
4.Flip lock herbst appliance4.Flip lock herbst appliance
5. The ventral telescope5. The ventral telescope
6. The magnetic telescopic6. The magnetic telescopic
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62. THE HERBST APPLIANCETHE HERBST APPLIANCE
Introduced by Emil Herbst in the year 1907
Popularized by PANCHERZ
Mechanics: Bilateral
telescopic mechanism
advancing the mandible
into a new position
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63. HERBST APPLIANCEHERBST APPLIANCE
TREATMENT EFFECTS OF HERBSTTREATMENT EFFECTS OF HERBST
DENTAL CHANGESDENTAL CHANGES
The mandibular teeth are moved anteriorlyThe mandibular teeth are moved anteriorly
Mandibular incisors are proclinedMandibular incisors are proclined
Maxillary teeth are moved posteriorlyMaxillary teeth are moved posteriorly
Maxillary teeth are distalized as well asMaxillary teeth are distalized as well as
intrudedintruded
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64. THE VENTRAL TELESCOPETHE VENTRAL TELESCOPE
This was the first telescopic RFFA that appeared as aThis was the first telescopic RFFA that appeared as a
single unit; i.e. upon reaching maximum opening it doessingle unit; i.e. upon reaching maximum opening it does
not come apart .not come apart .
Its disadvantages lie in the fact that it is quite thick andIts disadvantages lie in the fact that it is quite thick and
suffers from fractures to the brake which stabilizes thesuffers from fractures to the brake which stabilizes the
joint. As with the other appliances where fixing isjoint. As with the other appliances where fixing is
achieved through ball attachments, great accuracy isachieved through ball attachments, great accuracy is
necessary with regard to inclination and the welding ofnecessary with regard to inclination and the welding of
components.components.
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65. THE MAGNETIC TELESCOPICTHE MAGNETIC TELESCOPIC
DEVICEDEVICE
This appliance has the advantage ofThis appliance has the advantage of
linking a magnetic field to the functionallinking a magnetic field to the functional
appliance. Its main disadvantages are itsappliance. Its main disadvantages are its
thickness, the laboratory work necessarythickness, the laboratory work necessary
to prepare it and the covering of theto prepare it and the covering of the
magnets.magnets.
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66. THE UNIVERSAL BITETHE UNIVERSAL BITE
JUMPER(UBJ)JUMPER(UBJ) (Calvez X., 1998).(Calvez X., 1998).
This is like a Herbst but is smaller in size andThis is like a Herbst but is smaller in size and
more versatile – it can be used in all phases ofmore versatile – it can be used in all phases of
treatment in mixed or permanent dentition, Classtreatment in mixed or permanent dentition, Class
II or III malocclusions.II or III malocclusions.
UBJs with nickel titanium coil springs do notUBJs with nickel titanium coil springs do not
need to be reactivatedneed to be reactivated
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67. THE BIOPEDIC APPLIANCETHE BIOPEDIC APPLIANCE
Designed by Jay Collins in 1997Designed by Jay Collins in 1997
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68. The Mandibular AnteriorThe Mandibular Anterior
Repositioning Appliance (MARARepositioning Appliance (MARA
Introduced by Douglas Toll of Germany inIntroduced by Douglas Toll of Germany in
1991.1991.
Mechanics: Bilateral
cams fitted to molar
stainless steel crowns
to advance mandible
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69. SABBAGH UNIVERSAL SPRINGSABBAGH UNIVERSAL SPRING
Is ideal for treating patients withIs ideal for treating patients with
Insufficient cooperationInsufficient cooperation
Late cases with little remainingLate cases with little remaining
growthgrowth
Illnesses of the upper respiratoryIllnesses of the upper respiratory
tract system, such as asthmatract system, such as asthma
Patients who are allergic to plasticsPatients who are allergic to plastics
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70. RITTO APPLIANCERITTO APPLIANCE
The Ritto Appliance can be described as aThe Ritto Appliance can be described as a
miniaturized telescopic device withminiaturized telescopic device with
simplified intra oral application andsimplified intra oral application and
activation The construction of thisactivation The construction of this
appliance is based on the mechanism andappliance is based on the mechanism and
function used in the Ventral Telescopefunction used in the Ventral Telescope
adapted for use in conjunction with a fixedadapted for use in conjunction with a fixed
applianceappliance
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71. HYBRID APPLIANCESHYBRID APPLIANCES
The calibrated force module.The calibrated force module.
Eureka spring.Eureka spring.
The twin force bite corrector.The twin force bite corrector.
FORSUS Nitinol flat spring.FORSUS Nitinol flat spring.
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72. THE CALIBRATED FORCETHE CALIBRATED FORCE
MODULEMODULE
It was a fixed appliance designed to substituteIt was a fixed appliance designed to substitute
Class II elastics and it was developed in 1988Class II elastics and it was developed in 1988
by the CorMar Inc.by the CorMar Inc.
Its coil spring produced a force of 150 gmsIts coil spring produced a force of 150 gms
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73. EUREKA SPRINGEUREKA SPRING
This appliance appeared on the marketThis appliance appeared on the market
in 1996 and it was developed byin 1996 and it was developed by
DeVicenzo and Steve Prins .DeVicenzo and Steve Prins .
Mechanics:
Telescopic rods
with integral
light force
compression
springs.
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74. FORSUS NITINOL FLATFORSUS NITINOL FLAT
SPRINGSPRING
The Forsus Nitinol Flat Spring is slim,The Forsus Nitinol Flat Spring is slim,
flat and made of Super-Elastic Nitinol.flat and made of Super-Elastic Nitinol.
Nitinol is always at work, deliveringNitinol is always at work, delivering
consistent forces. Force levels remainconsistent forces. Force levels remain
constant from the initial setup to theconstant from the initial setup to the
time of removal.time of removal.
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75. ALPERN CLASS II CLOSERSALPERN CLASS II CLOSERS
It consists of a small telescopic applianceIt consists of a small telescopic appliance
with an interior coil spring and two hookswith an interior coil spring and two hooks
for fixing .for fixing .
It functions in the same way as elasticsIt functions in the same way as elastics
and, similarly, is fixed to the lower molarand, similarly, is fixed to the lower molar
and to the upper cuspid.and to the upper cuspid.
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76. DENTAL CLASS II – TREATMENTDENTAL CLASS II – TREATMENT
OPTIONSOPTIONS
MAXILLARY MOLARS
MOVED FORWARD
MESIAL IN ROTATION
OF THE MAXILLARY
MOLARS
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77. MAXILLARY MOLARS MOVEDMAXILLARY MOLARS MOVED
FORWARDFORWARD
GOOD FACIAL
PROFILE
POOR FACIAL
PROFILE
MOLAR
DISTALIZATION
EXTRACTION
PROXIMAL
STRIPPING
14, 24, 35, 45 AND
FINISH THE CASE IN CLASS I
14, 24, AND
FINISH THE CASE IN CLASS II
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78. A number of appliances have beenA number of appliances have been
introduced for molar distalisation.introduced for molar distalisation.
CLASSIFICATIONCLASSIFICATION
EXTRA ORALEXTRA ORAL
Head gears--- a. cervicalHead gears--- a. cervical
b. occipitalb. occipital
INTRA ORALINTRA ORAL
RemovableRemovable
Fixed------------- Buccally actingFixed------------- Buccally acting
Palatally actingPalatally acting
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81. Palatally actingPalatally acting
Distal jet applianceDistal jet appliance
Cricket applianceCricket appliance
Nance applianceNance appliance
Pendulum appliance and its modificationPendulum appliance and its modification
Simple molar distaliserSimple molar distaliser
Intra oral bodily distalising applianceIntra oral bodily distalising appliance
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82. MESIAL IN ROTATIONMESIAL IN ROTATION
Often, in a class II malocclusion,Often, in a class II malocclusion,
the maxillary first molars are rotatedthe maxillary first molars are rotated
mesiolingually. Correcting this rotationmesiolingually. Correcting this rotation
moves the buccal cusps posteriorly andmoves the buccal cusps posteriorly and
provides at least a small space mesial toprovides at least a small space mesial to
the molars.the molars.
Cetlin, JCO, 1988
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83. Treatment plan – molar rotationTreatment plan – molar rotation
Transpalatal archTranspalatal arch
Tip back bendTip back bend
Nance palatal archNance palatal arch
Head gearHead gear
Couple forceCouple force
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85. CAMOUFLAGE TREATMENTCAMOUFLAGE TREATMENT
Beyond the adolescent growthBeyond the adolescent growth
spurt to correct a skeletal problem teethspurt to correct a skeletal problem teeth
should be displaced relative to theirshould be displaced relative to their
supporting bone to compensate for thesupporting bone to compensate for the
underlying jaw discrepacy. This is termedunderlying jaw discrepacy. This is termed
camouflage treatment.camouflage treatment.
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86. Indications for class II camouflage treatment:Indications for class II camouflage treatment:
Too old for successful growth modification.Too old for successful growth modification.
Mild to moderate skeltal class II.Mild to moderate skeltal class II.
Reasonably good alignment of teeth.Reasonably good alignment of teeth.
Good vertical facial propotionsGood vertical facial propotions
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87. Extractions in class II:Extractions in class II:
Extraction of upper first bicuspids only withExtraction of upper first bicuspids only with
lower non extractionlower non extraction
Extraction of upper first bicuspids andExtraction of upper first bicuspids and
lower second bicuspidslower second bicuspids
Extraction of upper and lower bicuspids inExtraction of upper and lower bicuspids in
cases with severe lower crowdingcases with severe lower crowding
Distalization of molars with second molarDistalization of molars with second molar
extraction.extraction.
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89. PRESURGICALPRESURGICAL
TO REMOVE THE DENTAL COMPENSATIONSTO REMOVE THE DENTAL COMPENSATIONS
THAT HAVE OCCURRED TO MASK THETHAT HAVE OCCURRED TO MASK THE
SKELETAL MALOCCLUSION AND TOSKELETAL MALOCCLUSION AND TO
FACILITATE THE SURGICAL PROCEDUREFACILITATE THE SURGICAL PROCEDURE
EXTRACTION PATTERN FOLLOWEDEXTRACTION PATTERN FOLLOWED
ACCORDING TO THE CLINICAL SITUATIONACCORDING TO THE CLINICAL SITUATION
TO CORRECT THE AXIAL INCLINATION OF THETO CORRECT THE AXIAL INCLINATION OF THE
ANTERIORSANTERIORS
TO BRING THE MOLARS TO FULL CUSP CLASSTO BRING THE MOLARS TO FULL CUSP CLASS
IIII
TO CREATE SUFFICENT OVERJETTO CREATE SUFFICENT OVERJET
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90. SURGICAL PROCEDURES:SURGICAL PROCEDURES:
In case of,In case of,
Maxillary excess- Le Fort I OsteotomyMaxillary excess- Le Fort I Osteotomy
Mandibular deficiency- Saggital splitMandibular deficiency- Saggital split
osteotomyosteotomy
Deficient chin- Advancement genioplasty.Deficient chin- Advancement genioplasty.
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91. POST SUGICALPOST SUGICAL
ORTHODONTICSORTHODONTICS
Can be initiated 3 to 4 weeks afterCan be initiated 3 to 4 weeks after
the release of immobilization. Stabilizationthe release of immobilization. Stabilization
arch wires are removed and replaced byarch wires are removed and replaced by
working arch wires with light vertical forcesworking arch wires with light vertical forces
till a good stable occlusion is achieved.till a good stable occlusion is achieved.
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92. CONCLUSIONCONCLUSION
WITH SUCH A WIDE RANGE OFWITH SUCH A WIDE RANGE OF
TREATMENT MODALITIES ANDTREATMENT MODALITIES AND
APPLIANCES LISTED OUT FOR CLASSAPPLIANCES LISTED OUT FOR CLASS
II MALOCCLUSION, IT IS AT THEII MALOCCLUSION, IT IS AT THE
HANDS OF A SKILLEDHANDS OF A SKILLED
ORTHODONTIST TO APPROPRIATELYORTHODONTIST TO APPROPRIATELY
TIME AND CHOOSE THE RIGHTTIME AND CHOOSE THE RIGHT
TREATMENT ACCORDING TO THETREATMENT ACCORDING TO THE
INDIVIDUAL PATIENT NEEDS.INDIVIDUAL PATIENT NEEDS.
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