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Leader in continuing dental education

1.Appliances producing pushing force a. Temporary Fixed Functional appliances Twin Block b.Permanent Fixed functional appliances I.Flexible Fixed functional appliances 1. The Jasper Jumper

5. The Klapper Super pring

2. The Amoric Torsion Coils

6 .The Bite Fixer

3. The Adjustable Bite Corrector

7. The Churro Jumper

4 - The Scandee Tubular Jumper


2.Rigid Fixed functional appliances – RFFA 1.Herbst Appliance

2.Cantilevered Bite Jumper

3.MALU Herbst Appliance

4. Flip-Lock Herbst Appliance

5.Ventral Telescope

6. Magnetic Telescopic Device

7.M P A

8. Universal Bite Jumper

9.BioPedic Appliance

10. (MARA)

11.IST – Appliance

12. Ritto Appliance


14. Active vertical corrector


3.Hybrid appliances Eureka spring

Twin force bite corrector

Forces correcters

Alpern class II correctors

Sabbagh springs II.Appliances producing pulling force SAIF springs

RFFAs do not easily fracture They do not allow to close in centric relation. Mandible is in a forward position 24 hours a day . Creating greater stimulus for mandibular growth Systems, utilizing ball attachments have appeared on the market in an attempt to: improve patient comfort and acceptance • cause fewer clinical problems compared to screw or pin attachments • reduce the frequency of emergency appointments • allow good lateral mandibular movements •

Herbst E., 1910; Pancherz H., 1979 Dentaurum It is a fixed bite-jumping device for treatment of Class II malocclusion. Several advantages (1) The Herbst appliance works 24 hours a day, (2) No cooperation from the patient is required, and (3) Treatment time is short Herbst appliance -- Distalizing force to the maxillary teeth -- Mesial force against the mandibular arch.


Diagnostic Criteria ---Proposed by PHILLIP GOODMAN, JCO,1985 Cephalometric Overview • Positive y-axis (Riedel) • Good symphyseal development • Relatively flat Go-Gn-SN relationship • Wits appraisal of -3mm or greater • Upper 1 to SN of 104° or greater • N-Me-S-Go ratio of 63% or greater • ANB of -5° or greater (SNA within normal limits) • Lower 1 to SN of 93° or less Facial Appearance • Retrognathic profile • Normal midfacial development • 1:1 ratio between tip of soft tissue nose to subnasale and subnasale to cheek crease


• Normal bizygomatic width • Pleasing facial appearance, normal lip competence when mandible is advanced • Normal lip-chin-throat angle Dental Appearance The upper and lower first molars and the permanent central and lateral incisors should be fully erupted. The lower incisors are upright If they are badly crowded, fixed appliance alignment will be necessary prior to functional appliance construction.


Parts of appliance A tube A plunger Two pivots, Two screws



Maxilary arch—lingual or buccal sectional wire Mandibular arch—lingual sectional wire Partial anchorage

Maxilary arch—Labial arch wire Mandibular arch—extended sectional wire Total anchorage

Appliance Construction (JCO, Volume 1981 Aug) 1.In nonextraction cases, upper and lower first molars and first premolars are banded. 2.In extraction cases, first molars and canines are banded. 2. Take a wax bite with the mandible in a forward position, 3. Take upper and lower impressions with bands seated. 4. Mount upper and lower casts hinge articulator, each side


5.The pivot must be soldered to the molar band 6. Disassemble screw, pivot, and tube. 8. Solder pivot. 9 For fine adjustment of the tube and rod, place rod into tube so that the shank of the rod is touching the end of the tube. 11. Solder a full lingual arch connecting the molar and premolar bands. 12. Solder either a full lingual arch or sectional lingual bars connecting the molar and premolar bands on

Patient Instructions --pain --Irritation --Chewing difficulty Clean the appliance Seen at regular intervals

Advantages Immediate esthetic improvement No damage to the pulp or periodontium Reduction in the number of appointments Usable in patients of any age Acceleration of condylar growth in children Anterior displacement of the mandibular incisors Prevents eruption of the maxillary molars Minimal cooperation


Appliance works with a constant force Diminishing the possibility of changing upper lip contour One-half of the changes are dentoalveolar Multiple design possibilities It is difficult to totally destroy or lose a Herbst

Dis advantages • A Class II bimax patient will become protrusive. • shouldn't expect to alter condylar position. • Since the Herbst affects the maxilla minimally •The appliance should be worn for 9 to 15 Mont. •The mandible has a limited range of motion, • impossible to use with some patients. . cost of the appliance,

TREATMENT EFFECTS ON THE DENTOFACIAL COMPLEX-- AJO1985 ,Pancherz Occlusal changes –Normal relations Sagittal cephalometric changes The mandibular incisors proclined. The position of the maxillary incisors was unaffected Restraining effect on maxillary growth A stimulating effect on mandibular growth. Apparent mandibular length increased. Vertical cephalometric changes

Intrusion of mand I and Max Molar Overbite reduced Lower facial Ht Increased

Journals Comparison of Herbst and Frankel appliances - McNamara, AJO 1990 --Prevented the vertical eruption of the upper first molar --Posterior movement of the upper first molar --A lingual tipping of the upper incisor was observed in both --Mandibular molar move forward in the Herbst group --Lower incisor anterior tipping. --Lower incisor moved 2 mm more anteriorly Both produced increases in mandibular length and varying increases in lower anterior facial height. Greater dentoalveolar effects were observed with the Herbst appliance than with the Fr채nkel appliance .

Journals Class II correction in Herbst appliance treatment - Pancherz AJO 1982 Aug (1--Class I occlusal relationships in all treated cases. (2--Skeletal and dental changes. (3--Increase in mandibular length, distal movement of the maxillary molars, mesial movement of the mandibular molars. (4--Overjet correction

Journals Effective condylar growth� and chin position changes in Herbst treatment: A cephalometric study-Hans Pancherz, AJO 1998 --Treatment period, effective condylar growth was relatively more backward directed and about three times larger . --During the first posttreatment period of 0.6 years, effective condylar growth recovered with respect to both the direction and amount of changes. --During the second posttreatment period of 2.5 years, effective condylar growth was “normal --The corresponding chin position a mirror image of effective condylar growth --In cases with anterior mandibular autorotation, relatively more forward and in cases with posterior mandibular autorotation relatively more backward directed chin position changes resulted.

Journals Headgear effect of the Herbst appliance - Pancherz – AJO 1993 1. 2. 3. 4. 5.

The maxillary molars were moved distally The maxillary molars were intruded The maxillary occlusal plane was tipped downward The palatal plane was tipped downward Sagittal maxillary jaw position seemed unaffected

Journals Long-term effect of treatment with headgear-Herbst appliance In early mixed dentition - Wieslander AJO 1993 Oct Negative findings are as follows: 1. A prolonged retention was necessary to minimize relapse 2. A modest long-term effect on the mandible 8 years after treatment. 3. A rather small increase in mandibular length. Positive findings are as follows: 1. A rapid improvement of the r jaw discrepancy 2. A significant maxillary effect during active treatment and retention.

Journals Class ll relapse after Herbst treatment Pancherz AJO 1991 Sep Relapse in the overjet and sagittal molar relationship resulted mainly from posttreatment maxillary and mandibular dental changes The main causes of the Class II relapse in patients treated with the Herbst appliance were a persisting lip-tongue dysfunction habit and an unstable cuspal interdigitation after treatment.

Journals Long-term TMJ effects of Herbst treatment: A clinical and MRI study -- Sabine Ruf AJO1998 ---25%) exhibited moderate to severe signs of temporomandibular disorders ranging from partial to total disk displacement or “deviation in form� of the condyle. ---(15%) showed mild symptoms of temporomandibular disorders with either small condylar displacement or subclinical soft tissue lesion. In conclusion, it can be said that Herbst treatment does not seem to have an adverse longterm effect on the temporomandibular joint.


Parasagittal MRIs of 4 Herbst patients exhibiting moderate to severe signs and symptoms of TMD. tracings are given next to each original image for better orientation. Dotted area represents a fibrotic adaptation of the bilaminar zone.

Journals The mechanism of Class II correction in late Herbst treatment Michael Konik, AJO 1997

The conclusion of the study was that the Herbst appliance is equally efficient in patients treated before and after the pubertal peak of growth. However, proclination of the lower incisors (anchorage loss) in late treated subjects is larger than in early treated subjects.

Journals Effect of Herbst appliance on TMJ Morphology—Kurt papowitch AJO 2003---A Literature review * Medline Best Evidence cochrane Enbase Changes in the condylar position to glenoid fossa are negligible

Journals Maxillary molar distalisation and enhancement;A Cephalometric comparision of Comprehensive orthodontic treatment including the pendulum and Herbst appliances.Donald.R.Burkhordt—AJO 2003 Herbst Pt—More Mand projection Mand Plane angle did not open up No Bite block effect (acrylic herbst ) Mand Dent moved anteriorly

MODIFICATIONS 1.Stainless steel crowns 2.Acrylic splint Herbst—B, R,FR(Embdon) 3.Cantilever Herbst—I,II,III 4.Edgewise Herbst 5.Thermoformed Herbst 6.MALU 7.Flip Lock 8.Swedish Style 9.Mixed Dention

Stainless steel crown Herbst Lang Ford---In Deciduous teeth

Bonded Acrylic splint Herbst RAYMOND P. HOWE JCO, 1982 Herbst design advocated by Pancherz and described by Langford has been problematic. 1.Appliance is attached to mandibular first bicuspid bands 2.Repeated breakage and loosening of the appliance 3.Rapid intrusion of the mandibular first bicuspids

By altering the original Herbst configuration, these limitations may be overcome

Bonded Acrylic splint Herbst

Removable Acrylic splint Herbst Removable Plastic Herbst Retainer - RAYMOND P. HOWE, JCO,1987 Useful in maintaining alignment, space closure, and rotation correction. In an effort to combine the useful properties of both singleand dual-arch retainers The design is similar to that of the Removable Plastic Herbst treatment appliance.

Removable Acrylic splint Herbst Other uses Finisher Post-Surgical Retainer. Aid for Obstructive Sleep Apnea Anterior Repositioning Splint

Fixed-Removable Herbst Appliance - TAREK ZREIK, D JCO, 1994 Apr Indications for the Emden Herbst include: • Class II malocclusion • Lack of patient cooperation • Blocked-out maxillary teeth where distalization of molars is indicated • Impacted canines requiring distalization of the upper molars • Maximum anchorage requirement • Temporomandibular dysfunction

Fixed-Removable Herbst Appliance 6 weeks

6 months

Advantages • It requires minimal cooperation. • It promotes patient acceptance • It allows more cases to be treated • It is easy to construct, fit, adjust, and clean. • Materials are inexpensive, • The lower splint increases anchorage,. • Maxillary tooth movement and torque control can be accomplished early, . full fixed appliances can be placed after correction of the Class II relationship.

Cantilever Herbst Appliance LARRY W. WHITE, JCO, 1994 May Type I—Non cooperative mixed dentition pt TypeII—Deep bite low angle class II pt Type III—Class I &II CASES WITH EXTRAT OF II pm and m

Edgewise Herbst Appliance TERRY DISCHINGER, JCO, 1995 Dec Advantages 1. There are no lingual wires to interfere with the tongue, and no forward tipping force on the lower incisors. 2. The lower arch can expand along with the upper arch. 3. Recementation is easy. 4. There is a lip bumper effect. 5. One lower bicuspid and lower cuspid on each side are free to erupt. 6. In the permanent dentition, the cantilever is lower in the vestibule than previously, resulting in less lip irritation. 7. The .019" ´ .025" CuNiTi wire eliminates the need to change archwires 8. The use of negative-torque brackets and the position of the archwire tube on the axle allow the mandibular arch to be leveled with just a straight archwire. .

Edgewise Herbst Appliance Disadvantages 1. There is more chance of interference with the rods and tubes and the cantilever arm on opening and closing. 2. If the stops are not properly positioned, the molar can tip and the crown may impinge on tissue. 3. There is a greater chance that the occlusion may dislodge a lower incisor bracket..

Mixed dentrition

Permnt dentition

Modified Edgewise-Herbst Appliance RAFFAELE SCHIAVONI, JCO, 1996 Dec

Mandibular Advancement Locking Unit MALU), MALU --- two tubes, two plungers, two upper “Mobee” hinges with ball pins, and two lower key hinges with brass pins

Modified Edgewise-Herbst Appliance Upper "Mobee" hinge inserted into hole on tube and secured to headgear tube with ball pin

Lower key hinge inserted into hole on plunger and locked to base arch with brass pin..

With upper and lower MALU components in place

The Flip-Lock Herbst Appliance ROBERT A. MILLER, JCO, 1996 Oct I Generation

II Generation

• Improved patient comfort and acceptance • Fewer clinical problems compared to screw or pin attachments • Less chairtime for reactivation • Less frequent emergency appointments

ball-joint connector III Generation

Split bushings used for reactivation.

End of rod crimped onto mandibular ball

The Swedish-Style Integrated Herbst Paul HAEGGLUND, JCO, 1997

A. Sliding auxiliary archwire, made of .9-1mm round stainless steel, inserted in lower first molar tube. B. Force of Herbst appliance distributed to main mandibular archwire by auxiliary archwire

Treatment Sequence •Alignment Phase. •Herbst Phase. 3 Adjustment Phase. 4.Retention Phase

The Ventral Telescope Professional Positioners First telescopic RFFA that appeared as a single unit

Great accuracy is necessary with regard to inclination and the welding of components.

The Magnetic Telescopic Device Ritto A.K., 1997 Consists of two tubes and two plungers with NdFeB magnets.

Advantage of linking a magnetic field to the functional appliance Disadvantages are its thickness, the laboratory work

The Mandibular Protraction Appliance (MPA) Filho C., 1995, 1997, 1998 FOUR different types MPA I MPAII MPAIII MPAIV

Advantages ease of manufacture, low cost, infrequent breakage, patient comfort rapid fitting






MPA IV CARLOS M COELHO,Jco 2001 Parts T Tube Upper molar Locking pin Mandibular rod Mandibular arch wire

The Universal Bite Jumper XAVIER CALVEZ JCO1998 Aug

A. B. C. D.

Universal Bite Jumper for fixed appliances. UBJ for fixed appliances with nickel titanium coil spring. Lateral UBJ for removable splints (Class II treatment). Lateral UBJ with coil spring for removable splints (Class III treatment). E. Median UBJ for removable splints (Class II treatment).

The BioPedic Appliance GAC International,

This is a bite jumping appliance which is engaged on the maxillary and mandibular molars, using a cantilever like system. It is then attached to a BioPedic buccal tube

The Mandibular Anterior Repositioning Appliance (MARA) AOA, Created by Douglas Toll of Germany in 1991

The IST – Appliance Sheu Dental

Intraoral Snoring-Therapy Appliance Hinz •The telescope is threaded so the orthodontist can change the protrusion on each side individually up to 8mm. •An end stop in the guiding sleeve prevents the telescope from disengaging.

The Ritto Appliance Ritto A.K The Ritto Appliance can be described as a Miniaturized telescopic device with simplified intraoral application and activation

The Ritto Appliance is simple to use, comfortable, cost effective, breakage resistant and requires no patient cooperation

a steel ball pin and a lock 25







Herbst appliance variations---Michel Rogers jco2003

Space closing Herbst Cantilevered herbst Expansion Herbst

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