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 Table of Contents  
Year : 2021  |  Volume : 12  |  Issue : 1  |  Page : 26-31

Fixed functional appliances for correction of Class II malocclusion: A review

Department of Orthodontics and Dentofacial Orthopedics, Kothiwal Dental College and Research Centre, Moradabad, Uttar Pradesh, India

Date of Submission08-Sep-2020
Date of Decision10-Dec-2020
Date of Acceptance08-Feb-2021
Date of Web Publication07-May-2021

Correspondence Address:
Dr. Fatima Alam
Abul Hasan House, Galshaheed, Prince Road, Moradabad, Uttar Pradesh
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijor.ijor_38_20

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This review article presents various fixed functional appliances that have been developed all these years with the aim of correcting Class II malocclusion. Class II malocclusion though multifactorial in etiology, but the main cause is mandibular retrognathia. The treatment aims to modify the direction and amount of mandibular growth rather than restricting the development of the maxilla. Hence, the various appliances were developed removable and fixed with the aim to correct Class II malocclusion. Fixed functional appliances were developed with the aim to correct Class II malocclusion without the need of patient compliance, which was a major concern toward removable functional appliances.

Keywords: Class II, fixed functional, malocclusion, retrognathic mandible

How to cite this article:
Ckauhan A K, Alam F, Verma S, Shafaq S. Fixed functional appliances for correction of Class II malocclusion: A review. Int J Orthod Rehabil 2021;12:26-31

How to cite this URL:
Ckauhan A K, Alam F, Verma S, Shafaq S. Fixed functional appliances for correction of Class II malocclusion: A review. Int J Orthod Rehabil [serial online] 2021 [cited 2021 Dec 1];12:26-31. Available from: https://www.orthodrehab.org/text.asp?2021/12/1/26/315630

  Introduction Top

Correcting Class II malocclusion has always been a challenge to an orthodontist owing to the complex and multifactorial etiology. It has been suggested in various studies that the main cause of Class II malocclusion is mandibular retrognathia. Treatment of Class II malocclusion aims to modify the direction and amount of mandibular growth rather than restricting the development of maxilla. This concept plays a primary role in functional jaw orthopedics. Various appliances have been developed over the past century, removable and fixed. The main drawback of the removable appliances is that they require very good patient cooperation. Due to noncompliance of the patient, which in general is increasing, alternate treatment strategies of functional appliances had been devised, broadly grouped as fixed functional appliances.[1] The ideal time for the treatment with fixed functional appliances takes the advantage of the pubertal growth. Being a 24-h wear appliance, it produces rapid sagittal correction utilizing the short span of remaining growth to maximum advantage.

  History of Evolution Top

Norman W. Kinsley who first (1879) used forward positioning of the mandible in orthodontic treatment. Wilhelm Roux is credited as the first to study the influences of natural forces and functional stimulation on form (1883) (Wolff's law). His work became the foundation of both general orthopedics and functional dental orthopedic principles. Viggo Andresen's Activator was the first functional appliance to gain the widespread clinical use. Fixed functional appliance was introduced by Dr. Emil Herbst of Germany at the 5th International Dental Congress in Berlin in the year 1909 which was later discovered by Pancherz in the late 1970s. Since then various functional appliances have been introduced, removable and fixed, with the basis of correcting Class II malocclusion by bringing the mandible in a forward position.[2]

  Functional Jaw Orthopedics Top

The original concept of functional jaw orthopedics is basically encompassing the correction of Class II malocclusion not only active force of the appliance but also by the forces generated from the muscles when the mandible is held forward.[3] The primary objective of functional jaw orthopedics (FJO) in Class II patients with mandibular skeletal retrusion is the enhancement of mandibular growth.[4],[5] Greater effects of FJO are expected when the treatment is carried out at the peak in the mandibular growth when compared to the outcomes of treatment performed before or after the growth spurt.[5] The effectiveness of functional appliance is not only limited to the measurement of the enhanced length of the mandible alone but also includes the improvement in overall volume of the oral cavity, i.e., housing the dentition, oral structures such as position of the tongue and soft-tissue drape around the face. Forward placement of the mandible is seen as an improvement in the lip seal and improved pattern of breathing.[6] Functional appliance worn for 24 h, like the Herbst appliance increases mandibular growth as claimed by Pancherz and as suggested by Herbst treatment time not <9 months.[7],[8],[9] Pancherz also suggested that functional appliance like the Herbst worn for 24 h increases mandibular growth, with an increase in arch length as well as proclination of the mandibular incisors along with distalization of the upper molars and mesialization of lower molars.[7],[10] The functional appliances used to treat retrognathic mandible, influence the jaws by remodeling of the mandibular condyle or glenoid fossa, repositioning of the mandibular condyle in the glenoid fossa, and auto-rotation of the mandibular bone, which occurred through intra-articular osseous or soft-tissue remodeling.[11],[12]

Various indications and contraindications for use of fixed functional appliances are listed in [Table 1]. Fixed functional appliances are classified as Rigid, Flexible, Hybrid and as substitute for elastics. The individual types are listed in [Table 2]. Further a brief description of each appliance type is given in [Table 3], [Table 4], [Table 5].
Table 1: Indications and contraindications

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Table 2: Classification

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Table 3: Rigid fixed functional appliances

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Table 4: Flexible fixed functional appliances

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Table 5: Hybrid fixed functional appliances

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  Treatment Effects Top

According to the study done by Zymperdikas et al., the treatment of Class II malocclusion with Fixed Functional Appliances (FFAs) was associated with small stimulation of mandibular growth, small inhibition of maxillary growth, and with more pronounced dentoalveolar and soft-tissue changes. The treatment effects of FFAs on the skeletal tissues in patients with Class II malocclusion excluding the effects of normal growth were small and probably of minor clinical importance.[29] In a systematic review presented by Perinetti et al., they concluded that treatment with the fixed functional appliance is effective in treating Class II malocclusion with skeletal effects when performed during the pubertal growth phase. The skeletal effects alone do not account for the whole Class II correction, dentoalveolar effects are always present, even in patients who are treated during puberty.[30]

  Conclusion Top

Class II malocclusion has multifactorial etiology, mandibular retrognathism being the main cause. Various functional appliances have been developed for the correction of class II. Fixed functional appliance has gained widespread popularity as the patient compliance is not needed. Treatment with the fixed functional appliances should not last <6–9 months. Forward positioning of the mandible and increase in mandibular length, as well as distalization of upper molars and mesialization of lower molars lead to the correction of class II malocclusion.

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Conflicts of interest

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  References Top

Weiland FJ, Bantleon HP. Treatment of Class II malocclusions with the Jasper Jumper appliance – A preliminary report. Am J Orthod Dentofacial Orthop 1995;108:341-50.  Back to cited text no. 1
Wahl N. Orthodontics in 3 millenia, Chapter 9: Functional appliances to mid-century. Am J Orthod Dentofacial Orthop 2006;129:6.  Back to cited text no. 2
McNamara JA Jr., Brudon WI. Orthodontics and Dentofacial Orthopedics. Ann Arbor: Needhom Press, Inc.; 2001.  Back to cited text no. 3
Franchi L, Baccetti T. Prediction of individual mandibular changes induced by functional jaw orthopedics followed by fixed appliances in Class II patients. Angle Orthod 2006;76:950-4.  Back to cited text no. 4
Hägg U, Pancherz H. Dentofacial orthopaedics in relation to chronological age, growth period and skeletal development. An analysis of 72 male patients with Class II division 1 malocclusion treated with the Herbst appliance. Eur J Orthod 1988;10:169-76.  Back to cited text no. 5
Voudouris JC, Kuftinec MM. Improved clinical use of twin-block and Herbst as a result of radiating viscoelastic tissue forces on the condyle and fossa in treatment and long-term retention: Growth relativity. Am J Orthod Dentofacial Orthop 2000;117:247-66.  Back to cited text no. 6
Pancherz H. Treatment of Class II malocclusion by jumping the bite with the Herbst appliance. Am J Orthod 1979;76:423-42.  Back to cited text no. 7
Nelson C, Harkness M, Herbison P. Mandibular changes during functional appliance treatment. Am J Orthod 1993;104;153-60.  Back to cited text no. 8
Pancherz H, Hagg U. Dentofacial orthopedics in relation to somatic maturation. An analysis of 70 consecutive cases treated with the Herbst appliance. Am J Orthod 1985;88:273-87.  Back to cited text no. 9
Nelson C, Harkness M, Herbison P. Mandibular changes during functional appliance treatment. Am J Orthod Dentofacial Orthop 1993;104:153-61.  Back to cited text no. 10
Arici S, Akan H, Yakubov K, Arici N. Effects of fixed functional appliance treatment on the temporomandibular joint. Am J Orthod Dentofacial Orthop 2008;133:809-14.  Back to cited text no. 11
Popowich K, Nebbe B, Major PW. Effect of Herbst treatment on temporomandibular joint morphology: A systematic literature review. Am J Orthod Dentofacial Orthop 2003;123:388-94.  Back to cited text no. 12
Pancherz H. The Herbst appliance – Its biologic effects and clinical use. Am J Orthod 1985;87:1-20.  Back to cited text no. 13
Coelho Filho CM. Mandibular protraction appliance IV. J Clin Orthod 2001;35:18-24.  Back to cited text no. 14
Ritto AK. Fixed functional appliances – Trends for the next century. Funct Orthod 1999;16:22-39.  Back to cited text no. 15
Pangrazio-Kulbersh V, Berger JL, Chermak DS, Kaczynski R, Simon ES, Haerian A. Treatment effects of the mandibular anterior repositioning appliance on patients with Class II malocclusion. Am J Orthod Dentofacial Orthop 2003;123:286-95.  Back to cited text no. 16
Blackwood HO 3rd. Clinical management of the Jasper Jumper. J Clin Orthod 1991;25:755-60.  Back to cited text no. 17
Castañon R, Valdes MS, White LW. Clinical use of the Churro jumper. J Clin Orthod 1998;32:731-45.  Back to cited text no. 18
West RP. The adjustable bite corrector. J Clin Orthod 1995;29:650-7.  Back to cited text no. 19
Moschos A, Papoudopolos. Orthodontic treatment of Class II non-compliant patients. Ist ed. China: Mosby Elsevier;2006. Chapter 11: The Flex Developer; 145-162.  Back to cited text no. 20
Awbrey JJ. The bite fixer. Clin Impressions 1999;8:10-7.  Back to cited text no. 21
Klapper L. The super spring II: A new appliance for non-compliant class II patients. J Clin Orthod 1999;33:50-5.  Back to cited text no. 22
DeVincenzo JP. The Eureka spring: A new inter arch force delivery system. J Clin Orthod 1997;31:454-67.  Back to cited text no. 23
Vogt W. The Forsus fatigue resistant device. J Clin Orthod 2006;40:368-77.  Back to cited text no. 24
Rothenberg J, Campbell ES, Nanda R. Class II correction with the Twin Force Bite Corrector. J Clin Orthod 2004;38:232-40.  Back to cited text no. 25
Moschos A, Papoudopolos. Orthodontic treatment of Class II non-compliant patients. Ist ed. China: Mosby Elsevier;2006. Chapter 14: The Sabbagh Universal Spring (SUS); 203-208.  Back to cited text no. 26
Moro A, Borges SW, Spada PP, Morais ND, Correr GM, Chaves CM Jr., et al. Twenty-year clinical experience with fixed functional appliances. Dental Press J Orthod 2018;23:87-109.  Back to cited text no. 27
Dischinger BM. Skeletal Class II case presentation: Utilization of the AdvanSync 2 appliance. APOS Trends Orthod 2018;8:168-74.  Back to cited text no. 28
  [Full text]  
Zymperdikas VF, Koretsi V, Papageorgiou SN, Papadopoulos MA. Treatment effects of fixed functional appliances in patients with Class II malocclusion: A systematic review and meta-analysis. Eur J Orthod 2016;38:113-26.  Back to cited text no. 29
Perinetti G, Primožič J, Furlani G, Franchi L, Contardo L. Treatment effects of fixed functional appliances alone or in combination with multibracket appliances: A systematic review and meta-analysis. Angle Orthod 2015;85:480-92.  Back to cited text no. 30


  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]


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