Pendulum Appliance Research Articles

Efficacy of Bone Anchored Pendulum Appliance Over Conventional Pendulum Appliance during Molar Distalization in the Orthodontic Management of Class II Malocclusion : A Systematic Review

Background: Pendulum appliance used commonly used to achieve molar distalization in the management of borderline class II malocclusion is associated with mesial tipping of the maxillary premolars and proclination of maxillary incisors post-distalization, resulting in round tripping and increased treatment time. Bone Anchored Pendulum Appliance (BAPA) is one of the modifications of the pendulum that could effectively prevent anchorage loss. Aim: To evaluate the effectiveness of Bone Anchored Pendulum Appliance(BAPA) over the Conventional Pendulum Appliance(CPA) for the distalization of maxillary molar in the management of Class II malocclusion. Materials and Methods: A web search was done in Google Scholar, MEDLINE, Web of Science, LILAC and COCHRANE Library databases using PRISMA guidelines. The search included RCTs and Non RCTs (Both Prospective and Retrospective studies) comparing distalization achieved by BAPA with CPA in Class II malocclusion. The Risk of bias was assessed using the ROBINS - I tool. Results: Of the initial 745 articles, 5 studies met the inclusion criteria and were included to the systematic review. The BAPA showed between 4.8 -6.4 mm of molar distalization and between 9 °-11.3° of distal tipping of molars while the distalization achieved with CPA was between 2mm -6.4mm with 6.67° -14.50° of distal tipping. While CPA groups showed mesial tipping of premolars, distal tipping of premolars was observed with the BAPA appliances. Conclusions: BAPA were found to significantly reduce anterior anchorage loss, distalise the premolars and molars. There is moderate evidence that BAPA provides greater distalization with reduced incidence of unwanted tooth movements.

Upper airways changes associated with orthodontic molar distalization by Pendulum appliance in adolescent patients: a multicenter retrospective cephalometric study

ObjectivesThe purpose of this multicenter retrospective study was to perform a two-dimensional analysis of upper airway changes in adolescent patients following molar distalization with the Pendulum appliance.Materials and methodsThe study involved the cephalometric analysis of 88 patients, retrospectively categorized into two groups: skeletal Class II with a dental Class II molar relationship (36 patients, mean age 12.6 ± 1.1 years) and skeletal Class I with a dental Class II molar relationship (54 patients, mean age 12.3 ± 1.2 years). Changes were observed using lateral radiographs before (T0) and after Pendulum appliance removal (T1); treatment time averaged 7 months. Upper airways were subsequently analyzed by tracing lateral radiographs. The Shapiro-Wilk test showed a normal distribution of the data, therefore parametric tests were used for statistical analysis. Intragroup changes between T0 and T1 were evaluated using paired t-tests, and intergroup differences were assessed using independent student t-tests; statistical significance was set at 0.05.ResultsStatistically significant differences were observed in the skeletal measurements that characterized both groups, particularly in ANB and Wits appraisal, at T0 (P < 0.001). After molar distalization, Class I and Class II groups reported no statistically significant differences with changes almost equal to zero between timepoints (P > 0.05). Additionally, intergroup comparisons of airway changes at T1 did not show statistically significant differences (P > 0.05).ConclusionsThe Pendulum appliance does not significantly change the upper airway dimensions in Class I and Class II malocclusion patients, thereby minimizing potential respiratory risks.

Enhanced pendulum appliance utilizing temporary anchorage device-based Nance arch and modified springs for optimized molar distalization control: a case report.

A 20-year-old female patient with severe maxillary crowding and skeletal Class III malocclusion was successfully treated using an enhanced pendulum appliance. Camouflage treatment was chosen because the patient refused surgical intervention. Detailed examination and analysis revealed that labial inclination of the maxillary anterior teeth could provide the alignment space necessary after tooth extraction in the maxillary arch but it would not be beneficial esthetically and would increase the moment perpendicular to the tooth long axis as well as increase the risk of bone dehiscence. Therefore, lingual inclination of the mandibular anterior teeth was performed. To create space for aligning the maxillary arch, an enhanced pendulum appliance was utilized, in addition to premolar extraction. The enhanced pendulum appliance had one mesial and one distal helix on each spring, exerting opposing forces in the buccolingual direction and reducing the buccolingual inclination of the molars. In addition, miniscrews were integrated into the Nance arch of the enhanced pendulum appliance to provide skeletal anchorage, minimizing the reciprocal movement of anchorage teeth. This modification not only enhanced control over tooth movement but also improved treatment efficiency. During the entire treatment duration of 17 months, substantial improvement in facial and occlusal aspects were noted. Additionally, the patient retained these positive changes until the subsequent 2-year follow-up period.

Correction of class II malocclusion with modified pendulum appliance – A case report

Treatment of Class II malocclusion with significant crowding might be achieved without extraction if an appropriate diagnosis is made. The current study presents the orthodontic treatment for a 12-year-old female patient who was diagnosed with end-on molar relation bilaterally on class I skeletal base with proclined upper anteriors and crowding in lower anteriors. Both in terms of appearance and occlusal function, the post-treatment results met the patients' expectations. This case report details the non-extraction treatment of a class II molar relation by distalization into a class I molar relation utilizing a modified pendulum appliance.

Comparative Evaluation of Molar Distalization Between Pendulum Appliance and Miniscrew Anchorage System: A Clinical Study

Introduction: Molar distalization is one of the treatment protocols in cases with mild to moderate arch discrepancy and class II molar relationship associated with a normal mandible. It is achieved by using pendulum appliance and temporary anchorage devices such as miniscrew anchorage system. Aims and Objectives: To evaluate and compare the dentoalveolar and skeletal changes between pendulum appliance and miniscrew anchorage system. Materials and Methods: The patients were divided into 2 groups of 10 each: group I (using the pendulum appliance) and group II (using miniscrew anchorage system). Lateral cephalogram was taken for each subject and various skeletal such as SNA, SNB, ANB, and PTV-A dentoalveolar (U1-PTV, U6-PTV, U5-FH, and U6-FH) measurements were taken. The data obtained were statistically analyzed using Statistical Package for Social Sciences (SPSS) software. Intragroup analysis between pendulum and implant group was done using Wilcoxon Matched pairs test and the intergroup analysis between pendulum and implant group was done using Mann–Whitney test. Results: The results showed that there was nonsignificant difference in both the groups ( p &gt; .05) with the less tipping in group II (1.2) than group I (2.7) .The molar extrusion was more with the pendulum group (2.1 mm) than the miniscrew anchorage distalization group (1.3 mm). Conclusion: The molar distalization using the miniscrew anchorage system showed more bodily movement than the pendulum appliance which showed more tipping movement. Moreover, the pendulum appliance showed significant amount of anchor loss than the miniscrew anchorage system.

Beauty of Distalization-case report

Maxillary molar distalization has been in used in orthodontics over a centennial. This approach has been used to attain space in the maxillary arch for relief of crowding, correction of Class II molar relationship and reduction of an increased overjet. This article reports the successful use of five molar distalization appliances, they are; the pendulum, distal jet, K- loop molar distalizer, double-loop Ni-Ti and the C- space regainer. All the five patients were in the age group of 12-20 years, who had Class II molar relationship with mild overjet and normal mandibular arch. In all the five patients maxillary molar distalization was efficient in correcting the borderline Class II malocclusion. Pendulum appliance was more efficient than others because it is easy to fabricate, cost-effective, less frequent activation and minimum anchorage loss. The practitioner requires a through understanding of the clinical indications of this procedure so that undue side effects can be minimized along with better incorporation in the orthodontic patient care.

Management of Class II Malocclusion with Modified Pendulum Appliance and Second Molar Extraction

Management of Class II Malocclusion with Modified Pendulum Appliance and Second Molar Extraction

Comparison of the Bone-Anchored Pendulum Appliance and the Bone-Anchored Intraoral Bodily Molar Distalizer: An Original Research.

With the advent of mini-implants, Class II correction has become routine. The study's goal was to compare the "Bone-Anchored Pendulum Appliance (BAPA)" to the "Bone-Anchored Intraoral Bodily Molar Distalizer (BAIBMD)" in terms of clinical efficacy. Five boys and five girls were among the 10 patients in this split-mouth trial who had to have their molars distalized. On one side, BAPA Construction, and on the other, BAIBMD was piloted. A titanium mini-screw was used to secure both appliances to the bone since this was a spilled-mouth technique. The first molar bands to apply 200 g of force were used for both devices, as with all the other components that were similar for both appliances. For both sides, the nature, duration, and rate of tooth movement were compared. Using the Wilcoxon signed-rank test, descriptive statistics for several parameters were examined. Distalization was accomplished on both sides with clinical success. The rate of distalization did not show any significant variation. Less time was needed for distalization with BAPA, as evidenced by the statistically substantial variances in treatment duration between the two groups. Molar tipping was noticed in BAPA, and it was statistically significant. While the pace of distalization was equal for both appliances, BAIBMD required more time than BAPA but resulted in a distal tooth movement that was mostly translatory in nature.

Driving the maxillary molar distally with infra-zygomatic crest implant: A case report

There has been increase in the treatment modalities for non-surgical Class II malocclusion. This has resulted in orthodontists becoming more vigilant with extraction treatment plans and exploring possible non-extraction treatment approaches. Maxillary molar distalization is one such method. The maxillary molar is distalized to create space and helps in solving the malocclusionMany appliance were used for the distalization of molars over the period of time. Both intra-oral and extra-oral methods are present. The extra oral appliance includes headgear and heavy elastics; whereas intra oral appliance include distal jet, jones jigs, pendulum appliance, k-loop, fixed functional appliances, magnets, ACCO appliance and use of TAD’s. Thus the use of IZC implants has been effective in distalization of molars.

Distalization, A unique weapon in an orthodontist’s armoury: A case series

Distalization is widely used as an effective method of gaining space with or without the need of extractions. Various Extra-oral and intra-oral appliances have been introduced over the years. The pendulum appliance and its modifications are specifically very popular among clinicians owing to their effectiveness. The present case series comprises of two cases that have been effectively treated using the pendulum appliance ensuing in aesthetically pleasing outcomes.

Management of palatal entrapment of mini-implant supported pendulum appliance: A case report

This case report describes the surgical management of mucosal entrapment of a mini-implant-supported molar distalization appliance.A 17-year-old female patient was referred for removal of a implant-supported pendulum appliance entrapped in the palatal mucosa, which is used for molar distalization by the Department of Orthodontics. The clinical findings suggested that the overlying soft tissue was non-inflammatory and occurred due to forceful impingement of the wire component on the palatal mucosa.Surgical intervention was planned for removal of the mucosal entrapped appliance. A V-shaped incision was made under local anesthesia to expose the wire. The Appliance was completely removed, and silk sutures were placed for proper primary closure. Healing was uneventful, with minimal discomfort.While there are risks associated with orthodontic treatment with fixed and removable appliances, they can be avoided by adopting the required measures during treatment and educating patients about their responsibilities.

Effects of Micro-osteoperforations on Maxillary Molar Distalization Using Miniscrew Anchored Pendulum Appliance: A Split-mouth Randomized Controlled Trial

Effects of Micro-osteoperforations on Maxillary Molar Distalization Using Miniscrew Anchored Pendulum Appliance: A Split-mouth Randomized Controlled Trial

Comparative study of transverse dental changes induced by palatally-buccally applied 2K-loop appliance and palatally applied pendulum appliance

Comparative study of transverse dental changes induced by palatally-buccally applied 2K-loop appliance and palatally applied pendulum appliance

Effects of pendulum appliance versus clear aligners in the vertical dimension during Class II malocclusion treatment: a randomized prospective clinical trial

BackgroundThe aim of the present study was to compare the effects on vertical dentoskeletal dimension produced by Pendulum appliance and Clear Aligners in patients with Class II malocclusion.Trial designThis is a prospective two-arm parallel group randomized clinical trial with 1:1 allocation ratio.MethodsThe Pendulum Group (PG) consisted of 20 patients (15F, 5 M) with a mean age of 17.2 ± 4.3 years. The Clear Aligners Group (CAG) comprised 20 patients (13F, 7 M) with a mean age of 17.2 ± 3.2 years. Distalization’s protocol in PG involved the activation of TMA wires till the achievement of Class I molar relationship. A protocol of sequential distalization was applied in the CAG. For each subject lateral cephalograms have been analyzed before treatment (T1) and at the end of the therapy (T2). Descriptive statistics and statistical between-group comparisons (PG vs CAG) were calculated for the craniofacial starting forms at T1 and for the T2–T1 changes. Statistical between-group comparisons for the T2–T1 changes were performed with independent samples t-tests (P < 0.05).ResultsThe PG showed significantly greater increases in SN^GoGn° when compared with CAG (+ 2.1 and − 0.3 degrees, respectively). Clockwise rotation of the occlusal plane with significantly greater increase of SN^POccl angle was observed in PG (+ 2.8 degrees) when compared with CAG (− 4.2 degrees).The PG revealed a significant increase in the N-Me variable with a mean change of + 4.4 mm compared to the CAG with mean values of − 1.2 mm. The PG showed an increase in the ArGo^GoMe angle (+ 0.7° degrees) compared to the CAG (− 3.4° degrees). The PG showed significantly greater increases in both maxillary and mandibular first molar to palatal plane (+ 1.3 and + 2.1 mm, respectively) when compared with CAG (− 0.9 and − 0.2 mm, respectively).ConclusionsUpper molar distalization with clear aligners represents a valid alternative to non-extraction treatment of Class II malocclusion, reducing the extrusion of maxillary first molars and improving the management of the occlusal plane and vertical dimension.Trial registration: ClinicalTrials.gov, NCT05298280. Registered 28 March 2022—Retrospectively registered, https://clinicaltrials.gov.

A new perspective on the relationship between anchorage and palatal morphology: Three-dimensional digital model analysis.

The tooth movements were generally analyzed in two dimensions on cephalometric radiographs. Nowaday, 3D digital model analysis, which does not have any harmful effects on patients, can be used to evaluate the palatal morphology and coronal tooth movements in a very comfortable and easy way. To investigate the effect of palatal morphology on anchorage reinforcement during intraoral molar distalization with pendulum appliance using 3D model analysis. The material consisted of before (T0) and after (T1) dental plaster models of Class II malocclusion patients (17 females, 3 males) treated with pendulum appliance for molar distalization and Nance appliance for anchorage. T0 and T1 digital models were superimposed using the palatal area as a reference via three points and surface-matching software, and the changes in teeth movement were calculated for left and right central incisors, first premolars, and first and second molars. Palatal morphology was evaluated at T0 on digital models as palatal inclination, palatal depth angles, and anterior hard palate area. Wilcoxon test was used to evaluate the treatment results and Spearman's correlation analysis was performed to evaluate the relationship between palatal morphology and dental movement. The upper limit for the level of significance was taken as 0.05. Mesial movement of first premolars and distal movement of first and second molars were found to be statistically significant (P < 0.001). A weak negative correlation was found between the palatal inclination and the movement of first premolars (P < 0.045 and P < 0.003). Palatal depth angles and anterior hard palate area had no correlation with dental movements. Presented results supported that the mesial movement of premolar teeth decreased as the inclination of the palate increased.

The Protraction Pendulum Appliance

James J Hilgers of california introduced the Pendulum Appliance in 1992 as mechanism for Class II non complaince treatment. The appliance uses a nance acrylic button for palatal anchorage and 0.036” TMA springs to deliver a light and continuous force to upper molars distalization without affecting palatal button [1]. Pendulum appliance can also be used for molar protraction both unilateral or bilateral by reversing the spring bend back and activating towards the molar to be protracted.

Molar Distalization using Orthodontic Implants-A Review &amp; A Case Report

Abstract : Treatment of class II malocclusion often require maxillary molar distalization. Some of the cases can be treated by non-extraction treatment modalities such as headgear, removable appliances, and intraoral distalizers such as the Pendulum appliance, Distal Jet, and Jones Jig. Anchorage loss from proclination of anterior teeth, distal tipping and increased overjet are major concerns with most of these appliances; some also require active patient compliance22. Keyword : Molar distalization, Skeletal anchorage, Temporary anchorage devices, Distalization appliances.

Correction of class II molar by molar distalization with pendulum appliance: A case report

Angle's Class II malocclusion with non- extraction method generally requires distal movement of the maxillary dentition, mesial movement of the mandibular dentition, or a combination of the two. A 14 year old female came with chief complaint of irregularly placed teeth. On clinical examination and analysis of relevant records, she was diagnosed as an Angle's Class II malocclusion, severely crowded maxillary arch with labially placed canines. She received non-extraction treatment that included bilateral maxillary molar distalization with the Hilgers pendulum appliance.

Non-extraction orthodontic treatment in a patient with severe anterior crowding

A 12 years 6 months old Indian male presented with a chief complaint of irregular upper and lower front teeth. Patient exhibited a mild convex profile on Class l skeletal base with slightly decreased vertical proportions. This was complicated by severe upper and lower labial segment crowding. Also the molar relationship was half unit class ll bilaterally. Since the patient did not want to go for extraction of premolars, treatment involved use of Pendulum appliance along with upper and lower pre-adjusted edgewise appliance (0.022x0.028” slot) with MBT prescription. Various elastics and overlay wires were used along with proximal stripping for the correction of severe crowding in upper and lower anterior teeth.: Clinically Angle’s Class I occlusion was achieved bilaterally with good intercuspal relationship. Vertical growth continued throughout the treatment.

Class II correction by maxillary molar distalization with pendulum appliance - A case report

24 year male patient presented with skeletal class II base with prognathic maxilla and orthognathic mandible. Angles class II division 1 subdivision malocclusion with proclined upper and lower anteriors, increase overjet, increased overbite, spacing with upper and lower anteriors, scissor bite with 35, class I molar and canine relation on right side, end on molar and canine relation on left side. Distalization was planned in maxillary arch to correct end on molar relation on left side and upper incisor proclination. Unilateral Pendulum appliance was used to distalize upper left molar. Post treatment Class I molar relationship was achieved bilaterally within 2-4 months with incisor proclination reduced. The total treatment ended in 18 months.