PENDULUM APPLIANCE.pdf

Orthodontic

1. PENDULUM
APPLIANCE

2. Introduction
Pendulum appliance
Design
Preactivation and Placement
Indications
Contraindications
Modifications:-
Conclusion
CONTENTS
•Pend –X
•T-REX
•M-Pendulum
•Modified pendulum with removable arms
•Pendulum K appliance

3. •Introduction
•In the past 20 years the distalization of the molars by the intraoral fixed
appliances has been used more often in the contemporary orthodontics.
Distalization of the molars with various appliances gives good result in the
treatment of dento-alveolar class 2 malocclusions and mild skeletal
discrepancies
•[1]. These appliances give to the orthodontist the opportunity to use non-
extraction treatment, where space gaining is required
•[2, 3]. The extra oral appliances are less often used for distalization, because
they are more uncomfortable for the patient and require a specific
cooperation.

4. •[4] The Pendulum applianceis one of the main and more
preferable appliances for molar distalization. Having a light
construction and great biomechanics the appliance is easily
adaptable by the patients.
•Using this appliance we achieve a space in the dental arch
with distalization of the medialized posterior teeth for the
correction of crowding, protrusion, decreasing of the
overjet and a Class 2 malocclusion.
•The gained space in the posterior segment is allocated in
the middle and anterior segment for the alignment of the
crowded teeth

5. مادختسا مت ، ةيضاملا نيرشعلا تاونسلا يفthe distalizationof the molars ةطساوبthe
intraoral fixed appliances يف نم ريثك نايحلأا ميوقت يفةرصاعملا نانسلأا.
•Distalizationof the molars ا عملأ ةةزجه ةفلتخملا ةجهيتن يطعي يف ةديجه جلاع dento-
alveolar class 2 malocclusions and mild skeletal discrepancies
حيتت هذه يئاصخلأ ةةزجهلأا ميوقت نانسلأا ةصرفلا مادختسلاnon-extraction treatment, ثيح
ةحاسم ىلع لوصحلا مةلي ابلاغ نوكت ام ةةزجهلأاThe extra oral امًادختسا لقأللdistalization
ابلاغ، بلطتتو ضيرملل اجهًاعةإ رثكأضيرملا نم ادًدحم انًواعت
The Pendulum appliance دحأ وه ةةزجهلأا ةيسيئرلا ل لاًيضفت رثكلأاوmolar distalization
لضفب ةعئارلا ةيويحلا اكيناكيملاو فيفخلا ءانبلا نكمي ةازجهلل ىضرمللوزسب فيكتلاةل
مادختساب سوق يف ةحاسم ققحن ةازجهلا اذه ةينسلا عمdistalization ةيفاخلا نانسلاا ةطيسولا
حيحصتل ماحدةلاا ءوتنلاوليلقتوoverjet and a Class 2 malocclusion
بيترتل يماملأاو طسولأا ءةجهلا يف يفلخلا ءةجهلا يف ةبستكملا ةحاسملا صيصخت متيلأاةمحدةملا نانس
Introduction

6. PENDULUM APPLIANCE
•JamesJ. Hilgers in 1992 introduced an appliance for class II correction in
non compliance patients.
•Design
•The “Pendulum Appliance” is consists of large Nance acrylic button in
palate for anchorage and 0.032’’ titanium molybdenum alloy (TMA)
springs that provide light and continuous force to maxillary first molars for
their distalization without having any affect on Nance palatal button.
•Acrylic button covers midpoint of palate and connected to upper first and
second premolars through occlusal rests. The two posteriorly directing
TMA springs are extending from the distal aspect of palatal acrylic to form
a helical loop near the midline and then extends laterally to insert into
lingual sheath on bands cemented on maxillary first molar.

7. •Springs have an adjustment loop that can be manipulated to increase molar
expansion, rotation and distal root tip.
•The anterior portion of the appliance can be retained in place with
occlusally bonded rests or soldered to bands on either the deciduous
molars or the first and second bicuspids.

9. •Pendulum appliance produces force of 200 to 250 grams in a swinging arc
like pendulum from midline, so it is named pendulum appliance.
According to Hilgerthe preactivation of appliance is done by bending
springs to 90 degree and approximately 30 degree is lost during insertion
of appliance resulting in 60 degree activation for distalization of molars.
•As molar distalizes, it moves on an arc (dis-topalatal arc) toward the
midline producing crossbite in molar. This tendency is counteracted by
opening the horizontal loop to increase expansion and molar rotation.
Distal root tip can also be produced by adjusting this horizontal loop on
the pendulum spring. Tipping back the recurved portion of the spring at
the loop causes a more direct distal movement of the molars.
Preactivation and Placement

10. •After the molars are back, a Nance space maintainer is custom made and
cemented to the upper molars to hold the space. The Nance space
maintainer will stay in the mouth for several months while the other
upper teeth are moved into their proper positions using full braces.
•Usually activation of appliance again is not needed and molars are moved
distally by 5mm in 3 to 4 months. Anchorage loss is minimum that is 1.5
mmin premolar area and 1-2 degreeproclination of maxillary anterios.

14. •The indications for the pendulum appliance are:
•(1) First phase of orthodontic treatment for unilateral or bilateral
distalization of maxillary first molar teeth for correction of Class II molar
relationship in non-compliant patients;
•(2) Space regaining in cases of mesial drift of upper first molarsdue to
early loss of primary molars;
•(3) Non-extraction treatment of mild to moderate crowding.
Indications

15. Contraindications
Skeletal or dental open bites.
Increased mandibular plane angle.
Increased lower facial height.
Increased overjetwith proclinationof maxillary incisors.

16. •It was also introduced by Dr. Hilgers. Its design
is same as original pendulum appliance except
for presence of a palatal expansion screw in the
midline.
•It is used in class II malocclusioncases where
transverse expansion is needed to correct
constricted maxillary arch.
PENDEX appliance
•The screw is activated one-quarter turn every 3
days, after a week for patient adjustment, to
produce a slow, stable expansion.
Modifications of Pendulum appliance

17. لبق نم اضًيأ هميدقت متDr. Hilgers . هميمصتوه سفنpendulum
appliance دوجهو ءانثتساب يلصلأاexpansion screw يف يكنح. طخ
طسولا
متي يف همادختسا تلااحclass II malocclusionثيح مةلي
transverse expansion يقفا عيسوت حيحصتل سوقيولعلا كفلا
متي قيضلانشيفيتكا عبر ةعسوملل لك ةرود3 عوبسأ دعب ، مايأ طبض نم
ضيرملل ةازجهلا ، جاتنلإ.تباثو ءيطب ددمت
PENDEX appliance

20. •This appliance is used for both maxillary
expansion and molar distalization.
•This appliance consists of two wires
extending from palatal acrylic and
soldered to lingual surface of maxillary
first molar bands
•These wires give additional stability
during expansion phase of treatment.
After completion of expansion, these
wires are removed and molar distalization
is started.
T-REX appliance

21. نم لكل ةازجهلا اذه مدختسيmaxillary expansion and molar distalization
نم نينثا نم ةازجهلا اذه نوكتيتارياولا نم نادتميكيليركلأا يكنحلااموحلموا ىلإ حطسل
طئارشلل يناسللاmaxillary first molar هذه رفوت ةفاضلإابتارياولا تًابث.حرم ءانثأ ةل
expansion نم ءازتنلاا دعب ، جلاعلا نمexpansion هذه ةلاةإ متتتارياولا
. ةيلمع ءدبتوmolar distalization
T-REX appliance

22. •M pendulum It was given by Dr. Scuzzo et al in
1999.
•In this horizontal pendulum loop is inverted, it
will allow bodily movement of both the roots and
crowns of the maxillary molars.
•Once the distal molar movement has occured,
the loop can be activated simply by opening it.
Modified pendulum appliance

23. لبق نم هؤاطعإ متDr. Scuzzo يف ماع1999
يف ةازجهpendulum متي ، اذه لا سكعhorizontal pendulum loop امم
ب حمسيbodily movement لا ناجهيتو روذجه نم لكلmaxillary molars
ةكرحلا ةاجهنا مت دق املاطةيلتسدلارلوملل،لا ليدعت نكميloopهحتف قيرط نع
Modified pendulum appliance

24. •Scuzzogave solution to these problems by introducing modified version of
pendulum in which springs of appliance can be removed for extra oral
activation.
•Rest part of appliance remains fixed. The active components of pendulum
appliance are inserted into acrylic sheaths of Nance palatal button and
these can be easily removed from sheaths for activation.
•This modified pendulum produces molar distalization at a rate of 1.5mm
per month and distalization of maxillary molars can be controlled more
accurately as compared to opening of loops intraorally.
Modified pendulum with
removable arms

25. .ب رضي امم تباث لودنبلا ةازجه ةفاظن مفلا نكمي لا كلذل ءارجهإ قيقد طيشنت لخاد ةازجهللامفل
مدقScuzzo لاًح نم لكاشملا هذزل للاخ نم ةلدعم ةخسن لاخدإpendulum ثيح. ةلاةإ نكمي
springs of appliance نم لجهأextra oral activation
لظي اتًباث ةازجهلا نم يقابلا ءةجهلا • لاخدإ متيThe active components of pendulum
appliance يف ةفلغأNance palatal button. نكميو نم ةلوزسب ازتلاةإازطيشنتل ةفلغلاا
جتني لا اذهpendulum لدعملاmolar distalization لدعمب1.5mm ايًرزش مكحتلا نكميو
يفdistalizationof maxillary molars رثكأ لكشب ةقد ةنراقم لا حتفبloops
Modified pendulum with
removable arms

27. •This appliance consists of an orthodontic screw which divides acrylic button
into two parts. Anterior component joins four anchorage teeth via wire
retainers and these wires are fixed to teeth with composite. The posterior
part consists of active pendulum springs. These springs are pre activated by
applying certain bends prior to insertion. The appliance is reactivated by
turning the screwwithout removing the springs from molar sheaths.
•This appliance allows translatory distalization of molars and also corrects or
prevents distal tipping and palatal movement. Uprighting activation in
appliance produces uprighting moment on molar roots and toe-in bend is
used for de-rotation of molars which have rotated mesially inwardly.
Pendulum K appliance

28. نم ةازجهلا اذه نوكتي يذلا ةعسوم مسقي ةعطقكيليركلأا ىلإنيأةجه .عبرأ يماملأا ءةجهلا مضي ة
anchorage teeth ربعتارياو متيو ةتبثم هذه تيبثتتارياولا ىلع نانسلأا مادختسابcomposit
نم يفلخلا ءةجهلا نوكتيactive pendulum springs هذه طيشنت متيsprings قيرط نع اقًبسم
ضعب قيبطت تاءانحنلاا لبقلاخدلإا . قيرط نع ةازجهلا طيشنت ةداعإ متي. ريودتthe screw نود
ةلاةإthe springs نم لا ةفلغاmolar
حمسي اذه ب ةازجهلاtranslatorydistalizationof molars وأ اضًيأ ححصيوعنميdistal
tipping and palatal movement
Uprightingactivation ةظحل جتني ةازجهلا يف هميقتسم روذجهلا ىلعرلوملا مدختسيوtoe-in
bend يف لا نارود ةلاةإmolars وحن تراد يتلالخادلا
Pendulum K appliance

30. Although many appliances are used for molar
distalization. But pendulum is very efficient
appliance.
Original pendulum has few limitations such
maintenance of oral hygiene and some anterior
anchorage loss but different modifications of
pendulum eliminate all shortcomings.
Modified pendulumcan also be used to correct
constricted arches along with molar distalization.
Conclusion

31. Thus pendulum and its modifications are best appliances for molar
distalization due to following features:
Comfortable to patient.
Achieve molar distalization without anterior anchorage loss.
Esthetically acceptable.
Easy maintenance of oral hygiene.
Less chair side

32. نم ديدعلا مادختسا نم مغرلا ىلع ةةزجهأdistalization نكلpendulum وه ةازجه لاعفةياغلل
Original pendulum هل ةفاظن ىلع ظافحلا لثم ةليلق دويق مفلا، وanterior anchorage loss ,
نكلوmodifications ةفلتخملاللpendulum يضقت نأ امك روصقلا هجهوأ عيمجه ىلع نكمي اضًيأ
مادختساModified pendulum ساوقلأا حيحصتل بنجه ىلإ ابًنجه ةقيضلا لا عمmolar
distalization
Conclusion
• نإف يلاتلابوpendulum and its modifications لضفأ يه ةةزجهأmolar
distalization ببسب تاةيملاةيلاتلا :
• ةحيرم ضيرملل
• لا قيقحتmolar distalization دقف نودanterior anchorage
•ايلامجه لوبقم
• ةلوزس ةفاظن ىلع ظافحلامفلا
•نم ليلقتلاchair side

33. THE END