IJDSR

FIXED FUNCTIONAL APPLIANCES- A REVIEW

Amandeep kainth1, Avkash Sakolia2, Disha Singh3, Himani Chopra4
1Registered Dental hygienist, Canada.
2,3
Post Graduate student 2nd Year, Department of Orthodontics & Dentofacial Orthopaedics,
Desh Bhagat Dental College& Hospital, Mandi Gobindgarh, Punjab.
4Dental Surgeon, Maxcare dental Home, Jalandhar.

Corresponding author:
Amandeep kainth, Registered Dental hygienist, Canada.
Email id: kainthaman2@yahoo.com, Contact No.-+2049990549

Abstract
Class II malocclusion is one of the most common malocclusion in orthodontic patients seeking orthodontic treatment and
it occurs in about one third of population. In growing patients skeletal discrepancy can be corrected by using removable
and fixed functional appliances. These appliances are capable of altering direction and amount of growth of individual. Use
of removable appliances needs patient compliance for their effectiveness. So to make these appliances non dependent on
patients, fixed functional appliances were introduced. This review will discuss the history, classification, indications and skel-
etal/dental effects of fixed appliances.
Keywords:Functional appliance, Mandible, malocclusion, camouflage.

Introduction the treatment time with the removable functional appliance was
Class II malocclusion is one of the most common malocclusion around one and one-half years, which was long enough to pro-
in orthodontic patients seeking orthodontic treatment and it mote non – compliance and burnout.
occurs in about one third of population. Class II malocclusion To avoid these problems of removable functional appliances,
may be due to skeletal or dental factors. Skeletal class II maloc- fixed appliances were introduced. Fixed functional appliances
clusion may be due mandibular retrusion, maxillary protrusion are those functional appliances that are fixed to the upper or low-
or combination of both. But most common component in class er jaws and which cannot be removed by the patient.
II patients is found to be mandibular retrusion.1 Origin of fixed functional appliance was started with Emil
In order to treat the full spectrum of malocclusions effectively, Herbst’s introduction of his appliance for the temperomandib-
a clinician must recognize and assess such developing skeletal ular joint patient in 1905.3 This appliance was reintroduced
pattern at an early age. If conservative orthodontic therapy can- by Hans Pancherz of Malmo, Sweden in 1979, which actually
not be provided at appropriate time, then such skeletal maloc- showed the potential of this appliance in stimulating the man-
clusions become worse and may have to be treated with surgical dibular growth.3
treatment or camouflage orthodontic treatment.2 Development of such appliances was aimed in eliminating the
Class II patients with retrognathic mandible, the ideal treatment need for patient compliance and placing treatment outcome under
is aimed to alter the amount or direction of growth of mandible the control of clinician. With fixed functional appliances, the treat-
for correcting malocclusion. This can be achieved with Func- ment duration was reduced to around 6 months. Beside this faster
tional appliances including removable and fixed devices that are result, it became possible to use the advantage of growth modifi-
capable to change the position of the mandible, both sagittal and cation treatment in those unfortunate patients who were near the
vertical direction and also can do supplementary lengthening of completion of growth and were unable to take treatment during
the mandible.1 early mixed dentition period .
The functional appliances are “those removable or fixed appli-
ance that alters the posture of mandible and transmits the force History of appliances
created by the resulting stretch of the muscle and soft tissue and The first ever fixed functional appliance was introduced by Ger-
change of neuromuscular environment to the dental and skeletal man professor Emil Herbst3, at the international dental congress
tissues to produce movement of the teeth and modification of in Berlin in 1905. Infact the appliance was originally recommend-
growth”3. ed for disorders of temperomandibular joint.
Initial removable appliances were bulkier and inconvenient and Herbst (1934)3 presented a series of article in the “Zahnartzliche
patient compliance was poor with these appliances. It was diffi- Rundschau” based on his experiences with the appliance. After
cult for patients to carry out normal functions like speaking and that, however very little literature was published on the subject and
mastication after wearing theses appliances. Furthermore, inter- the treatment method was more or less forgotten.
mittent wear does not elicit continuous muscle activity, which is Baume LJ, Derichsweiler H (1960)5 using fixed inclined planes
very much needed for promoting the skeletal change4 in young monkeys observed condylar head assuming a prolonged
Failure to adhere to prescribed schedule by patient, usually seen bilobed shape and increased cartilage proliferation resulting in in-
with removal appliances resulted in slow treatment response or crease of length of mandible.
some time no response at all. Therefore successful orthodontic The honour of reintroducing Herbst appliance goes to Hans
treatment with removable functional appliances was depen- Pancherz (1979)3 of Malmo, Sweden. He called attention of the
dent on patient cooperation in wearing of the appliance. Also orthodontic society to the possibility of stimulating mandibular

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growth by “jumping the bite” with the help of Herbst appliance. 3) MALU Herbst Appliance
Using Herbst appliance, Hans Pancherz showed that Class II cor- 4) Flip-Lock Herbst Appliance
rection could be treated successfully in 6 months, without patient 5) Ventral Telescope
cooperation. Sagittal mandibular growth was increased by treat- 6) Magnetic Telescopic Device
ment and contraction of muscles change towards normalcy. 7) Mandibular Protraction Appliance
Langford NM Jr (1981)6 wrote about the modification in Herbst 8) Universal Bite Jumper
appliance to reduce pushing forward of lower anteriors. He used 9) BioPedic Appliance
the full lingual arch which prevents the pushing of the lower ante- 10) Mandibular Anterior Repositioning Appliance
riors forward, which was a problem mentioned by Dr. Pancherz. 11) IST – Appliance
He also observed for expansion of the upper first premolars, if a 12) Ritto Appliance
full upper lingual arch is not used. This is due to the rotation of
the molar during treatment, which causes premolar expansion via III) Hybrid Appliances
the sectional lingual bars. Upper anterior brackets and an archwire 1) Calibrated Force Module
from premolar to premolar can be used to control this expansion 2) Eureka Spring
Raymond P.Howe (1982)7 introduced the bonded Herbst appli- 3) Twin Force Bite Corrector
ance to overcome some of the problem encountered with earlier 4) Forsus – Fatigue Resistant Device
designs. The principle difference between the original and pro- 5) Alpern Class II Closers
posed appliance design is that the paired telescoping elements,
which had been attached to the lower bicuspid bands, are now Moschos A. Papadopoulos’s classification17
attached to the entire lower dental arch by an acrylic bite splint. Appliance Author
Coelho Filho (1995)8 introduced the mandibular protraction ap-
pliance (MPA) for class II treatment. Initially he introduced MPA (A) Rigid intermaxillary appliances (RIMA)
1 and MPA 2. 1) Herbst appliance
Calvez X (1998)9 presented the universal bite jumper. It can be • Banded Herbst design Pancherz (1979)
used in mixed or permanent dentition. It can be used in class III • Cap Splint Herbst design Pancherz (1997)
patients by mounting it in a reverse configuration. • Stainless Steel Crown Langford (1982),
D.D.Guner et al (2003)10 evaluated the effect MARS on temporo- Herbst design Dischinger (1989)
mandibular joint using single photon emission computerized to- • Acrylic Splint Herbst design
mography. ( cemented or bonded) Howe (1982)
Meanwhile, James J Jasper (1987)11 developed a new and more (removable) Howe (1987)
flexible fixed functional appliance that allow lateral movements, (upper bonded and lower
the Jasper Jumper (JJ). removable) McNamara (2001)
West R.P (1995)12 had deviced the Adjustable Bite Corrector. It • Goodman’s modified Goodman and
is stretchable closed coil spring. The push force is generated by a Herbst McKenna (1985)
nickel titanium wire in the center of lumen of the spring. Its ad- • Upper Stainless Steel crown Valant (1989)
vantage is that it can be used on either side left or right. And lower acrylic
Devincenzo J (1997)13 introduced a new interarch force delivery • Flip- Lock Herbst design Miller (1996)
system, the Eureka spring. Better patient cooperation and en- • Hanks Telescoping Hanks (2003)
hanced esthetic because of reduced size are the major advantages Herbst design
claimed besides reducing cost and inventory. • Open bite intrusion Dischinger (2001)
Klapper Lewis (1999)14 introduced the super spring II in non Herbst design
compliant class II patients.
Thus the fixed functional appliance has undergone various modi- 2) Mandibular Advancing Clement and
fications by the hands of talented clinicians, they have tried to use Repositioning Splint (MARS) Jacobson (1982)
the concept in a way suitable to their existing practising system of 3) Cantilever bite jumper (CBJ) Mayes (1996)
orthodontics. 4) Molar moving Bite Mayes (1998)
Classification of Fixed Functional Appliances Jumper (MMBJ)
Ritto’s classification15,16 5) Mandibular Corrector Jones (1985)
I) Flexible Fixed Functional Appliances (FFFA) Appliance (MCA)
1) Jasper Jumper 6) Mandibular Protraction Appliance (MPA)
2) Amoric Torsion Coils Type I Coelho Filho (1995)
3) Adjustable Bite Corrector Type II Coelho Filho (1997)
4) Scandee Tubular Jumper Type III Coelho Filho (1998)
5) Klapper Super Spring Type IV Coelho Filho (2001)
6) Bite Fixer 7) Mandibular Anterior Eckhart (1998)
7) Churro Jumper Repositioning Appliance (MARA)
8) Ritto Appliance Ritto Orthod
II) Rigid Fixed functional appliances (RFFA) Cyber-J Archives
1) Herbst Appliance 9) Functional Mandibular Kinzinger (2002)
2) Cantilevered Bite Jumper Advancer (FMA)

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(B) Flexible intermaxillary appliances (FIMA) posterior area. Increase in EMG activity was observed, increase
1) Jasper Jumper Jasper (1987) seen greater in masseter and than temporalis muscle due to
2) Scandee Tubular Jumper change in sagittal jaw base/ dental relationship after six month of
3) Flex Developer (FD) Winsauer (2002) treatment with this appliance.
4) Amoric Torsion Coils Amoric (1994) Wieslander L 21 did intensive treatment of severe Class II maloc-
5) Adjustable Bite West (1995) clusion in early mixed dentition using a special headgear-herbst
Corrector appliance. The treatment duration was for 5 months. Results of
6) Bite Fixer Awbrey (1999) treatment revealed:
7) Gentle Jumper Change in sagittal relation of 7.5mm. The posteriorly directed
8) KlapperSuperspring II Klapper (1999) impact on the maxilla was seen about 3.1 mm which is due com-
9) Churro Jumper Castanon (1998) bined effect of distal movement of the dentoalveolar arch and of
10) Forsus Nitinol Heinig&Goz (2001) distal translation of maxilla. The anteriorly directed effect upon
Flat Spring the mandible of 4.4 mm was mainly due to anterior movement of
11) Ribbon Jumper the basal part of that bone, with a small part resulting from labial
movement of the lower incisors.
(C) Hybrid appliances (combination of RIMA and FIMA) It was reported that the displacement resulting from fixed func-
1) Eureka Spring DeVincenzo (1997) tional appliances was mainly dentoalveolar in nature. There is
2) Sabbagh Universal - Spring (SUS) forward and downward displacement of lower incisors which
3) Forsus Fatigue - is the most pronounced dentoalveolar effect of these applianc-
Resistance Device es followed by mandibular molar displacement. The mandible is
4) Twin Force Corbett and Bite Corrector Molina (2001) rotated in the forward and downward direction, but maxillary
dentition showed posterior and superior displacement. 22
Indications of fixed functional appliances:18 The Jasper Jumper and the Herbst appliances are effective in
• The correction of skeletal abnormality in young growing in- maxillary anterior displacement restriction. In addition to this,
dividuals including skeletal class II with retrognathic man- the Jasper Jumper was also found to be more effective in restrict-
dible and skeletal class III with maxillary retrusion. ing the increased effective length of maxilla.23
• To use of the residual growth left in neglected post adoles- Jasper Jumper, Herbst and MPA appliances were used to stim-
cent patients who have already passed the maximal pubertal ulate and/or redirect mandibular growth, but no significant
growth. difference was observed between the experimental and control
• In adult patients, these appliances can be used for: individuals in relation to the mandibular length. Therefore, these
• Distalization of the maxillary molars to correct dental class appliances do not seem to significantly influence mandibular
II molar relationship. growth.24,25
• Enhancing anchorage. The MPA produced significantly greater palatal inclination in re-
• As a mandibular anterior repositioning splint in patients lation to the control group.23 This could be actually consequent
having temporomandibular joint disorders. to the appliance effect and/or also to the non-significantly great-
• Conditioning of muscles in presurgical stage in patients er labial inclination and protrusion of the maxillary incisors in
with class II malocclusion. this group. This result is commonly seen during the use of fixed
• Post surgical stabilization of class II / class III malocclusion functional appliances.26-28 But, the Herbst appliance produced
significantly greater protrusion of the maxillary incisors than the
Skeletal and dental effects of appliances control group.
Functional Jaw Orthopaedic treatment responds well in actively Jasper Jumper and Forsus appliance, both are effective in correc-
growing individuals. In 1979, Panchrez performed a cephalo- tion of class II malocclusion. These appliances produce restric-
metric evaluation of class II patients treated with Herbst appli- tion of maxillary growth, improve maxillomandibular relation-
ance by jumping the bite. Treatment duration was 6 months and ship, overjet, overbite and molar relationship. They also induce
findings were19: clockwise rotation of occlusal plane, restrict vertical maxillary
• Achievement of normal occlusion in all patients; molar development, intrusion of mandibular molars and retru-
• Slight reduction in SNA indicating maxillary growth restric- sion of upper lip.29
tion or redirection; Woodside DG, Metaxas A, Altuna G30 found significant changes
• Increased SNB showing greater than average mandibular in the glenoid fossa following Herbst therapy in growing mon-
growth; keys. He observed the formation of large volume of new bone in
• Increased mandibular length supportive of condylar growth anterior border of post glenoid spine and resorption along the
stimulation; posterior border of spine. He observed thickening of articular
• Reduction in hard and soft tissue convexity19 disc which stabilizes the anterior condylar displacement.
Pancherz H and Anehus-Pancherz M. 20 investigated the effect
of continuous bite jumping on masticatory muscle activity using Conclusion
EMG records , in Class II division 1 malocclusion treated with Fixed functional appliances are effective in the management of
the Herbst appliance . It was reported that EMG activity before Class II malocclusion.
treatment for masseter muscle was less than the temporalis mus- These appliances are the only successful bite-jumping treatment
cle. With Herbst appliance, the mandible was jumped forwardly for noncompliant, postpubertal patients that does not require
to an incisor edge to edge position with no occlusal contact in orthognathic surgery at a later stage. Fixed functional appliances

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are reported to correct Class II skeletal problems by encouraging 16. Ritto AK. Fixed functional appliances – A classification (up-
mandibular growth and by inducing dentoalveolar effects. The dated). Cyber journal. June 2001
changes in the condyle caused by these appliances are assumed 17. Papadopoulos M A. Orthodontic treatment of the Class II
to be a result of mechanical stimulus of the fibrocartilage layer of Non-compliant patient current principle and techniques.
the condyle, such as for long bones with similar structure. Thus Mosby Elsevier; 2006.
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further explore the association with morphologic changes of the Journal of Current Research.2017; 9, (03):47407-47414.
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ances can be provided to patients for correcting their malocclu- ing the bite with the Herbst appliance: a cephalometric in-
sions. vestigation. Am J Orthod. 1979; 76: 423-442.
20. Pancherz H. Pancherz MA. Muscle activity in class II Div.I
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