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

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

2. 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. www.indiandentalacademy.com

3. 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 www.indiandentalacademy.com

4. PENDULUM SPRINGS www.indiandentalacademy.com

5. 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 www.indiandentalacademy.com

6. 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 www.indiandentalacademy.com

7. 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) www.indiandentalacademy.com

8. 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. www.indiandentalacademy.com

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10. 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 www.indiandentalacademy.com

14. 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 www.indiandentalacademy.com

16. 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 www.indiandentalacademy.com

18. 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 www.indiandentalacademy.com

19. INSTA NANCE www.indiandentalacademy.com

20. PEND X A pendulum appliance with an expansion screw The screw is activated one quarter turn every three days www.indiandentalacademy.com

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

23. 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 www.indiandentalacademy.com

24. 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 www.indiandentalacademy.com

25. 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 www.indiandentalacademy.com

26. 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 www.indiandentalacademy.com

30. 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 www.indiandentalacademy.com

31. 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 www.indiandentalacademy.com

33. 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 www.indiandentalacademy.com

34. 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 www.indiandentalacademy.com

38. 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 www.indiandentalacademy.com

42. 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 www.indiandentalacademy.com

43. 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 www.indiandentalacademy.com

47. 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 www.indiandentalacademy.com

50. 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 www.indiandentalacademy.com

52. 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 www.indiandentalacademy.com

55. 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 www.indiandentalacademy.com

57. 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 www.indiandentalacademy.com

60. 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 www.indiandentalacademy.com

61. 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 www.indiandentalacademy.com

62. 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 www.indiandentalacademy.com

63. 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 www.indiandentalacademy.com

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

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

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