Download The Pendulum Appliance Indications and Clinical

The Pendulum Appliance
Indications and Clinical Management
Doz. Friedrich K. Byloff
Graz, Austria
Some important aspects in constructing the Pendulum Appliance are outlined
as follows:
• The coil springs are made of .032 TMA wire (Ormco).
• The P.A. is bonded either to the upper bicuspids or to the primary
molars (Fig. 1,2,4) by means of auxiliary 0.32 inch TMA or
stainless-steel wires using composite resin and avoiding occlusal
interferences. They can approach the tooth from the distal or the
mesial (Fig. 1,2,4).
• An expansion screw is incorporated, only if necessary, to correct arch
width discrepancies (Fig. 1).
• The acrylic Nance portion should not touch the incisors and should not
reach too far distal to the coil spring, as intraoral insertion might be
difficult (Fig. 1,2,4).
• A perfect fit of the acrylic on the palatal mucosa should be achieved
during bonding of the P.A. (Fig. 1,2,4).
• The palatal sheaths on the molars, made by GAC should have an 8°
angulation as this facilitates intraoral insertion (Fig. 11).
• The plane of the coil springs should be parallel to the maxillary plane
(or occlusal plane / Fig. 3).
• Initial activation should not exceed 250 grams with the arms bent back
at about 45° (already prepared by the lab-technician / Fig. 2).
• It is important to note that the part of the spring inserted into the lingual
sheath is recurved for better control of distal movement and vertical
dimension. Note that the second part of the recurved end is shorter
than the first one to provide for better intraoral grip with a weingart plier
during reactivation and uprighting (Fig. 5,6,7,8).
Some important aspects in activating and reactivating the Pendulum Appliance
are outlined as follows:
• We reactivate intraorally, if necessary after 2 - 3 months! (Fig. 11)
• First the molar(s) should be distalised into an overcorrected Class I
relation (if one is correcting a Class II).
This can take up to 4 months.
• Uprighting is accomplished using an „uprighting bend“ of 10° to 15°
which is introduced intraorally with a weingart plier (as seen on models
in Fig. 5,6,7,8). Please note that reinsertion might be somewhat tricky
and the appliance will usually stay in place 2 - 3 months until the molar
is sufficiently uprighted.
• As already mentioned, the expansion screw is used only if needed.
Activation is usually one turn every 3 days until the necessary
expansion is obtained.
Some important aspects in removing the Pendulum Appliance are outlined as
follows:
• The same day the P.A. is removed a Nance arch (Fig. 9) should be
inserted. This is left in place for several months. Here again perfect
fit of the acrylic part of the Nance appliance on the palatal mucosa is
recommended (Fig. 10). It is also recommended that the Nance arch
be soldered to the upper molar bands (Fig. 9,12).
• After ca. 3 - 4 months, fixed appliances are used as the last step in
treatment (Fig. 12).
Some important „tips and tricks“ when using the Pendulum Appliance are
outlined as follows:
• Sometimes brackets are bonded as early as possible in the lower arch
to allow the earliest insertion of a solid arch which can be used as
anchorage when using Class II elastics. Such elastics may be
necessary as light support when distalising the upper dentition.
• We leave the Nance arch in place during the levelling phase and then
cut it off. It is for this reason that the molar must already be perfectly
uprighted by the P.A. (Fig. 12).
• Anchorage preservation is essential throughout the time with braces.
This is of the utmost importance as molars tend to move forward again.
• We almost never use Headgears to support anchorage in finishing but, it is of course possible.
Some important guidelines on how to choose the type of case which is most
suited for the Pendulum Appliance:
• Clinically we suggest to correct only cusp to cusp Class II
relationships. We do not use the P.A. in full Class II cases nor
skeletal Class II cases with significant overjet.
• We have had good experience in Class III tendencies with upper arch
crowding by using the P.A. for space creation.
• The P.A. can be used unilaterally to correct unilateral Class II
relationships by activating one side.
• In young adults we sometimes extract second molars, distalise the
first molar with the P.A. and then let the third molar erupt into the space
left by the extracted second molar.
Finally:
It is important to remember that during the P.A. phase there is a mesialisation
of the premolars and incisors (ref. 2,3,4). These must subsequently be
redistalised very carefully with fixed appliances. Anchorage preservation is of
the utmost importance to prevent undesirable relapse.
Literature on the P.A.:
Hilgers JJ.: The Pendulum Appliance for Class II non-compliance therapy.
J.Clin.
Orthod. 1992; 16:706-14.
Ghosh J., Nanda RS.: Evaluation of an intraoral maxillary molar
distalisation technique.
Am J. Orthod. Dentofac. Orthop. 1996; :639-46.
Evaluation of an intraoral Maxillary molar distalization technique
Ghosh J and Nanda RS
AJODO 1996;110: 639 – 96 (december)
Byloff F.K., Darendeliler M.A.: Distal molar movement using the Pendulum
Appliance. Clinical and radiological evaluation: Part 1.
Angle Orthod. 1997;67:249-60.
Byloff F.K., Darenedliler M.A., Clar E., Darendeliler A.: Distal molar
movement using the Pendulum Appliance. Part 2: The effects of maxillary
molar root uprighting bends.
Angle Orthod. 1997; 67:261-70.
Dentoalveolar and skeletal changes associated with the pendulum appliance
Bussick T Jand Mc Namara J A
AJODO 2000;117:333-43 (march)
Modified Pendulum Applince Including Distal Screw and Uprighting
Activation for Non-Compliance Therapy of Class II Malocclusion in Children
and Adolescents
G.Kinzinger, R. Fuhrmann, U. Gross, P. Dietrich, et al.
J Orofac Orthop 2000;61:175-90
Effects of the Pendulum Appliance on the Dentofacial Complex
Jose Chaques-Asensi, Varum Klara
J. Clin. Orthd. 35: 254-257, 2001
Maxillary molar distalization or mandibular enhancement: A
cephalometric comparison of comprehensive orthodontic treatment
including the pendulum and the Herbst appliances
D. R. Burkhardt, J. A.Mc Namara and T. Baccetti
AJODO 2003 ;123:108-1
Molar Distalization with Different Pendulum Appliances: In Vitro
Registration of Orthodontic Forces and Moments in the Initial Phase
G.Kinzinger, C.Syree, U. Fritz, P. Diedrich, et al.
J Orofac Orthop 2004;65:389-409
Molar Distalization with a Modified Appliance-In Vitro Analysis of the Force
System and in Vivo Study in Children and Adolescents
G. Kinzinger, H. Wehrbein, P. Dietrich
Angle Orthod 2005;75:484-493
Anchorage quality of deciduous molars versus premolars for molar
distalization with a pendulum appliance
Kinzinger GSM, U. Gross, U. Fritz, P. Dietrich
Am J Orthod Dentoacial Orthop 2005;127:314-23
Sagittal, vertical, and transverse changes consequent to maxillary molar
distalization with the pendulum appliance
Fuziy, R. Rodrigues de Almeida, G. Janson, F. Angelieri, and Pinzan
AJODO 2006 ; 130 :502-10
Dentoalveolar and skeletal changes associated with the pendulum appliance
Followed by fixed orthodontic treatment
F.Angelieri, R. Rodrigues de Almeida, M. Rodrigues de Almeida, and A Fuziy
Am J Orthod Dentofacial Orthop2006;129:520-7
Cervical headgear vs pendulum appliance for the treatment of moderate skeletal
Class II malocclusion
Claude F.Mossaz, Friedrich K.Byloff, and Stavros Kiliaridis
Am J Orthod Dentofacia lOrthop 2007;132:616-23
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