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1. FIXED FUNCTIONAL
APPLIANCE IN BEGGS

2. CONTENTS :
INTRODUCTION
BEGG MECHANISM
INDICATION OF FIXED FUNCTIONAL
FIXED FUNCTIONAL APPLIANCE IN BEGG
MPA NO I TO IV
CHURRO JUMPER
EVAA APPLIANCE
FORSUS NITINOL SPRING
CONCLUSION

3. INTRODUCTION
Use of functional appliance in treatment of CL II (defecient mandible )is
widely accepted now .
Successful orthodontic treatment in functional appliances often relies onSuccessful orthodontic treatment in functional appliances often relies on
patient co-operationpatient co-operation in wearing of appliances.in wearing of appliances.
Compliance of patients is reduced and greater control in treatmentCompliance of patients is reduced and greater control in treatment
established with fixed functional appliances.established with fixed functional appliances.

4. BEGG MECHANISM MORE THAN ENOUGH:
YOUNG PATIENTS WITH FAVOURABLE GROWTH PATTERN
MILD CL II (end on molar relation over jet up to 5mm )
DO NOT NEED FUNCTIONAL APPLIANCES
Bite opens maxillary arch form is widened in canine premolar area
Impediment to mandible growth is removed .
A GENTLE FORWARD PULL FROM LIGHT CL II ELASTICS HAVE A
FUNCTIONAL APPLIANCE LIKE EFFECT
UPRIGHTING OF UPPER MOLARS , UNDER THE ACTION OF ANCHOR
BENDS IN THE UPPER ARCH WIRE CORRECTS THE MOLAR
RELATION TO CL I

5. INDICATIONS OF FIXED FUNCTIONAL APPLIANCE :
CL II MALOCCLUSION SEVERE
(RETROGNATHIC MANDIBLE)
PATIENT END OF GROWTH SPURT
GROWTH DIRECTION IS UNFAVOURABLE
FIXED FUNCTIONAL APPLIACES PROVES BENEFICAL ALONG WITH BEGG

6. TYPES OF FIXED FUNCTIONAL APPLIANCES USED WITH BEGGS
1. MPA NO I TO IV
2. CHURRO JUMPER
3. EVAA
4. FORSUS NITINOL SPRING

7. FIXED FUNCTIONAL APPLAINCES IN BEGGS
who prefer to correct Class II malocclusions through mandibular
protraction.
1) MANDIBULAR PROTRACTION APPLIANCE :
1) APPLIANCES ATTACH TO LOWER ARCH WIRE (CANINE )
AND TO UPPER ARCH WIRE (MOLAR )
FILHOS APPLIANE
MPA NO 1 TO MPA NO IV

8. Advantages
include ease of fabrication,
low cost,
patient comfort,
and rapid installation.

9. Mandibular Protraction Appliance No.1 with stops placed in
mandibular archwire distal to cuspids.
Mandibular Protraction Appliance No. I
The first type of mandibular protraction appliance (MPA)
requires stainless steel ribbon archwires in both arches.

10. Small loop bent at right angle to end of .032" stainless
steel wire.
Appliance length measured from mesial of
maxillary tube to mandibular archwire stop
with mandible in proper protruded position.
CONSTRUCTION STEPS

11. Small right-angle loop bent in
opposite direction into other end of
.032" stainless steel wire.
Circles closed with plier after
appliance placement.
One appliance circle is placed over the
maxillary archwire against the molar tube,
and the other circle against the mandibular
archwire stop.

12. Appliance slides distally along mandibular archwire and mesially
along maxillary archwire upon opening. B. Buccal offset in lower
archwire to allow clearance for sliding.

13. DISADVANTAGE
the impossibility of bonding the lower bicuspids
combined with the appliance's limited mouth opening
and frequent dislodgment of molar bands,
Breakage of brackets.

14. MPA No. II made with right-angle circles in two
pieces of .032" stainless steel wire.
Coil of .024" stainless steel wire
slipped over one wire.
MPA NO II

15. One end of each wire inserted through other wire's loop.
Travel of each wire limited by wire coil.
The coil prevents the two wires from
interfering with each other and ensures
their correct relationship

16. Improper relationship of wires is prevented by coil.
Maxillary archwire has occlusally directed
circles against molar tubes;
mandibular archwire has occlusal circles
2-3mm distal to each cuspid.

17. Measurement between mesial surface of
maxillary molar tube and mandibular circle.
Appliance length transferred to wire
assembly;
attachment loops bent in wire ends for
maxillary and mandibular occlusal circles.

18. Attachment loops inserted into archwire
circles and squeezed closed.

19. MPA NO II AFTER INSERTION.

20. DISADVANTAGE
DIFFICULTY IN CONSTRUCTION IN CHAIR SIDE

21. MPA NO III
The new appliance still resembles the Herbst, but its smaller size and
improved function make it much more tolerable than previously
developed MPAs or Herbst appliances, and its ease of construction and
insertion reduce stress and discomfort for both doctors and patients.

22. Appliance Construction
1• Two maxillary tubes of .045" internal diameter, each about
27mm long
2• Two maxillary loops of .040" stainless steel wire, each about
13mm long, with a loop bent into one end at an angle of about
130° to the horizontal
3• Two mandibular rods of .036" stainless steel wire, each
about 27mm long
4• Four pieces of band material
• Two short lengths of annealed .036" stainless steel wire, each
with a loop in one end, for attaching the appliance to the
maxillary molar headgear tube
4
1
2
3

23. Maxillary loop welded to maxillary tube.

24. Two pieces of band material welded around
maxillary components.

25. Mandibular archwire with “O” loops distal to cuspids.
winding the wire twice around a Tweed loop-forming plier
019" ´ .025" wire, but smaller and more flexible wires such as .016" ´ .022" and .017" ´ .025
have reportedly resisted breakage with the MPA No. III.

26. Mandibular rod with 90° bend at one end and small piece of
tubing welded to shorter leg.

27. Mandibular rod inserted through “O” loop of archwire and
manipulated upward.
Place a small piece of tubing over the same end, then crimp and weld it so it stays
fixed. Insert the longer leg of the mandibular rod through the “O” loop in the
archwire from the lingual. Manipulate the rod upward until it is nearly perpendicular
to the wire

28. Appliance Placement
Place the mandibular archwire in the mouth so that enough wire extends distal to
the molar tube for a bend-down tieback
The maxillary arch can be fully or partially bonded, using any type and size of
archwire—round or edgewise, stainless steel or nickel titanium. This wire can be
tied back or not, depending on whether en masse movement of the maxillary teeth
or merely distal molar movement is desired.

29. Attach the maxillary tube to the distal end of the maxillary first
molar headgear tube by threading the short, annealed stainless
steel pin through the loop of the MPA tube and then through the
headgear tube. Bend the annealed pin down mesial to the
headgear tube

30. Ask the patient to position the mandible to correct any
overbite, overjet, and midline deviation, then use the
assembled maxillary tube to measure the distance from the
distal end of the headgear tube to the “O” loop on the
mandibular archwire. Mark and cut the tube at this point
completed MPA No. III, after sizing and cutting with mandible
in corrected position.

31. Class II patient with MPA No. III in place, showing
maximum opening.

32. Adaptations of the MPA No. III
Nickel titanium open-coil spring placed over mandibular
rod, reducing orthopedic protrusion.
If the maxillary tube assembly is cut short
of a fully protruded mandibular position, a
nickel titanium open-coil spring (.045"
internal diameter) can be placed over the
mandibular rod between the maxillary tube
and the end of the rod

33. MPA No. III reversed for Class III treatment, with open-coil spring
between appliance tube and rod loop.

34. . B. Class III version of MPA No. III provides maxillary anterior anchorage for
mesial movement of posterior teeth.

35. ADVANTAGES
• It is more comfortable for the patient, and thus promotes
better compliance.
• It offers greater range of motion.
• It is equally simple and inexpensive, but easier to place.
• It is adaptable to either Class II or Class III cases.
• It can be used for mandibular positioning or dentoalveolar
movement.
• It causes less breakage of archwires and appliances and
thus fewer emergency appointments.

36. Mandibular Protraction Appliance IV
The latest version, the MPA IV,is much
easier to construct and install, and much more
comfortable for the patient. The MPA IV is made
up of the following parts:
Molar tube
Upper molar locking pin.
Mandibular rod
Mandibular archwire

37. Spot-weld two perpendicular sections of
.040" stainless steel tubing to hold them in place
until soldering
This process can be repeated
several times along the longer tube, as long
there is at least 37mm between shorter tubes.

38. 2. Solder each spot-welded intersection
longer and shorter tubes

39. 3. Cut off the excess of each shorter tube flush
with the longer section
Cut the longer section flush with the short tube.
The excess tubing can be reused. Several sets of molar tubes and
mandibular rods can be prefabricated at one time
and saved for later use.

40. 4. Fabricate the upper molar locking pin by
adding a small drop of silver solder to one end
of
a section of .040" stainless steel wire.

41. 5. Insert the molar locking pin into the smaller
section of the tube, and pull it through until
the solder drop catches against the tube. Mark
the molar locking pin with a pen at the point
where it emerges on the other side of the tube

42. 6. Remove the molar locking pin, and bend it
gently at the ink mark with a three-prong plier
. Reinsert the molar locking pin all the
way into the smaller section of the tube.

43. 7. Insert a piece of .040" stainless steel wire
into the longer section of tube to prevent
deformation of the tube,
then bend the mandibular locking pin with
finger pressure until it is parallel
to the longer tube.

44. 8. Cut the molar locking pin to a manageable
length, and anneal its tip to make it easy to
bend during installation

45. 9. Fabricate the mandibular rod by making a
90 ｰ
bend at one end of a section of .036" stainless
steel wire, forming a longer and a shorter leg.
Add a small drop of solder to the tip of the
shorter
leg.
10. Insert the mandibular rod into the molar
tube
.

46. Installation
1. The .019" ⋅ .025" stainless steel mandibular
archwire must have two small circular loops
extending occlusally just distal to the cuspids
.

47. 2. Insert each mandibular rod into a circular
loop from the lingual, pull it through, and turn
it upward

48. 3. Insert each molar locking pin into a
maxillary
.045" first molar tube from the distal.

49. , then mark
the intersection of each tube with the
corresponding
circular loop of the mandibular archwire
. This defines the length of
MPA IV so that it will keep the mandible in
protracted position at rest. Also mark each
molar

50. 4. Remove each maxillary assembly from the
molar tube, and cut the molar locking pins and
tubes at the marks.
5. On each side, while holding the tube with
a plier, insert the mandibular rod into the tube
. Grasp the molar locking pin with
plier, and insert it into the maxillary .045"
molar
tube from the distal . Complete
insertion by pushing the assembly forward with
finger.

51. The MPA IV can be activated on either or
both sides simply by winding a section of
nickel
titanium coil spring over the mandibular rod.
The
amount of activation will be determined by the
number of turns in the coil .

52. CHURRO JUMPER
DR CASTANON
NAME SUGGESTS MEXICAN CINNAMON TWIST
IMPROVEMENT TO MPA
MORE LIKE JASPER JUMPER .
IN CLASS II MODE
JUMPER ATTACHED TO MAXILLARY MOLARS BY PIN THAT PASSES
THROUGH THE ADDITIONAL TUBE

53. MESIAL CIRCLE ATTACHED TO MANDIBULAR ARCH WIRE BY
SQUEEING IT SHUT
CHURRO JUMPER BOWS OUTWARDS WITH ACTIVATION ,
EXERTING FORCE DISTALLY AGAINST MAXILLARY MOLAR AND
MESIALLY AGAINST MANDIBULAR ARCH.

54. IN SEVERAL MONTHS ,CHURRO JUMPER CORRECTS CLASS
II MALOCCLUSION AND RETURNS INTO PASSIVE STATE

55. CONSTRUCTION
15 –20 SYMMETRICAL AND CLOSELY PLACED CIRCLES MADE IN .
028” TO .032” WIRE
CIRCLES MADE WITH BIRD BEAK PLIER OR TURRET MADE FROM
LARGE WOODEN DOWEL ,SMALL NAIL AND SPINDLE.
BY BENCH WISE

56. 2)ADDITIONAL WIRE IN AUXILLARY TUBE ON UPPER MOLAR
(LIKE JASPER JUMPER OR CHURRO JUMPER )
BETTER PERMITS A CONVENTIONAL BEGG SET UP TO CONTINUE
CORRECTIONS IN UPPER A RCH SUCH AS INTRUSION AND
RETRACTION
LOWER ARCH WIRE USED TOGETHER WITH FFA BE A HEAVY ARCH
WIRE (PREFERABLY RECTANGULAR)

57. LABIAL ROOT TORQUE GIVEN IN LOWER INCISORS .
UPPER MOLARS PROVIDED WITH DOUBLE ROUND TUBES
LOWER MOLAR BAND CARRY COMBINATION (ROUND AND
RECTANGULAR RIBBON TUBES )

58. JUMPER FITTED AFTER WELL ALIGNED
SO THEY RECEIVE RECTANGULAR O.O25”*O.O18 RIBBON WIRES
OMISSION OF BICUSPID BRACKETS AND OFFSETTS DISTAL TO
CANINE BRACKETS ALLOW CHURRO JUMPER TO SLIDEFREELY
ON MANDIBULAR ARCH WIRE

59. LENGTH OF JUMPER
MEASUREMENT FROM MESIAL OF
MAXILLARY HEADGEAR TUBE TO
DISTAL OF MANDIBULAR CUSPID BRACKET
LENGTH OF CHURRO
JUMPER AFTER
ADDING 12MM TO MEASUREMENT

60. PIN MADE OF ANNEALED .036” USED TO SECURE MAXILLARY
CIRCLE
PIN ACTIVATED BY PULLING IT FORWARD AND DOWN
CASES WITH WELL ALIGNED LOWER ARCHES THE
UPPER BEGG STRAP UP MAY BE COMBINED WITH A
LOWER EDGE WISE STARP UP

61. ADVANTAGES
CONSTANT FORCE ,
CORRECT CLASS II OR III MALOCCLUSIONS
HELPS MAINTAIN ANCHORAGE
USED UNILATERALLY OR BILATERALLY .
COST OF CONSTRUCTION VERY CHEAP AND CAN BE
FABRICATED IN CLINIC .
UNIVERSAL IN SIZE AND CAN BE ADAPTED TO FIT ANY
MALOCCLUSION.

62. DISADVANTAGE
WEAK BOND STRENGTH OF BEGG BRACKETS (small bonding
area and weak mesh )
HEAVY FORCES EXERTED BY JUMPER MAY DISLODGE THE
BEGG BRACKETS .
RESTRICTED MOUTH OPENING.

63. EVAA APPLIANCE
DESCRIBED BY VAN DER SCHUEREN AND DE SMIT IN JCO 1994
EVAA STANDS FOR (IN DUTCH)EXPERIMENTAL FIXED APPLIANCE
ACTIVATOR )
IT IS A SOLID BLOCK OF ACRYLIC WITH PROTRUDING WIRES THAT ARE
INSERTED INTO THE TUBES OF UPPER MOLAR BANDS

64. CONSTRUCTION OF EVAA
APPLIANCE IS CONSTRUCTED SO THAT MANDIIBLE IS FORCED
INTO A FORWARD POSITIION IN CLOSING
UPPER AND LOWER IMPRESSIONS FOR THE EVAA TAKEN WITH
FIXED APPLIANCE IN PLACE
ADDITIONAL ATTACHEMENT OF ROUND TUBE TO BE PLACED
OCCLUSAL TO CONVENTIONAL BEGG ROUND TUBE ON UPPER
MOLAR BANDS

65. APPLIANCE MADE AFTER UPPER AND LOWER ARCHES ARE
WELL ALIGNED (like correction of in standing lateral incisors ,
widening of upper arch in canine premolar area )
CONSTRUCTION BITE SHOULD BE AS CLOSE AS POSSIBLE TO AN
EDGE TO EDGE INCISAL POSITION( same as other functional
appliances )
Average cases sagittal advancement is 5 to 6mm and vertical clearance
is 3 to 4 mm
If greater vertical control required in high angle cases the thickness of
wax bite increased to 6 -8 mm , sagittal advancement is reduced .
midline considerations same

66. DESIGN OF EVAA
APPLIANCE CONSISTS OF RIGHT AND LEFT OCCLUSAL
BLOCKS JOINED BY LOWER PLATE
IT IS ANCHORED IN OCCLUSAL TUBES OF UPPER MOLARS
WITH THE HELP OF ‘U’ LOOP WIRE ELEMENTS EMBEDDED IN
THE BITE BLOCKS
THE FLANGES EXTEND IN THE LINGUAL VESTIBULES
ANTERIORLY APPLIANCE CAN BE KEPT FREE OF
CONTACTWITH THE LOWER INCISORS TO MINIMIZE THEIR
PROCLINATION OR FOR RETRACTION

67. INDENTATIONS ON THE BITE BLOCKS ARE NOT TRIMMED IF
MOLR MOVEMENTS IN VERTICAL OR SAGITTAL DIRECTIONS ARE
TO BE RESISTED (HIGH ANGLE CASE)
BITE BLOCKS ARE PARTICULARLY USEFUL ON LOWER MOLARS
IN NEGATING THE EXTRUSIVE EFFECT OF THE CLASS II
ELASTICS
IN NORMAL OR LOW ANGLE CASES . THE LOWER SIDE OF THE
BITE BLOCK CAN BE TRIMMED SIMILAR TO ACTIVATOR TRIMMING
IF SAGITTAL OR VERTICAL MOVEMENTS OF THE POSTERIOR
TEETH IS DESIRED

68. DURATION OF WEAR
PATIENTS WHO ARE NEARING THE END OF GROWTH SPURT
SHOULD WEAR THE EVAA ATLEAST 16 HOURS A DAY FOR 5 TO
6 MONTHS
THOSE WITH EXTREME SKELTAL DEFICENCIES SHOULD WEAR
IT DAY AND NIGHT EXCEPT DURING MEALS FOR 5 TO 6 MONTHS
WHICH MAY BE EXTENDED BY 3 TO 4 MONTHS FOR NIGHT TIME
WEAR
OPENING AND ADJUSTING THE MOLAR ANCHORING WIRE
LOOPS CAN ACHIEVE ADDITIONAL FORWARD POSITIONING OF
THE MANDIBLE

69. ADVANTAGES
INEXPENSIVE
CONSTRUCTION EASY
ACCEPTED WELL BY PATIENTS
INTEGRATED WITH BEGG PRACTISE (ANY FIXED APPLIANCE )
DURATION OF TREATMENT REDUCED .
ONLY ADDITIONAL ATTACHEMENT REQUIRED IS ONE MORE ROUND
TUBE
AFTER FUNCTIONAL THERAPY THE FIXED APPLIANCES CAN REMAIN
IN PLACE FOR FINISHING IF DESIRED
MORE ORTHOPEDIC EFFECTS WITH MINIMAL DENTOALVEOLAR SIDE
EFFECTS

70. DISADVANTAGE
LIMITED ABILITY TO PRODUCE TRANSVERSE AND ROTATONAL
CORRECTIONS IN THE MOLAR REGION

71. FORSUS NITINOL FLAT SPRINGFORSUS NITINOL FLAT SPRING
The flat nickel titanium spring attaches toThe flat nickel titanium spring attaches to
maxillary molar bands with an attached pinmaxillary molar bands with an attached pin
and loop assembly that slides into theand loop assembly that slides into the
headgear tube from the distal and cinchedheadgear tube from the distal and cinched
on the mesial.on the mesial.
Link n loopLink n loop
Prevents the pin from being droppedPrevents the pin from being dropped
during insertion.during insertion.
Allows the patient to open wider.Allows the patient to open wider.

72. Other end connected to mandibular main archwire or auxillaryOther end connected to mandibular main archwire or auxillary
bypass archwire.bypass archwire.
A bayonet bend placed distal to canines to act as forward stop.A bayonet bend placed distal to canines to act as forward stop.
1&2premolar brackets removed to allow greater range of action of1&2premolar brackets removed to allow greater range of action of
spring.spring.

73. EVEN THOUGH THE FIXED FUNCTIONAL APPLIANCES VARYEVEN THOUGH THE FIXED FUNCTIONAL APPLIANCES VARY
MUCH IN THEIR DESIGN THE DENTAL AND SKELETALMUCH IN THEIR DESIGN THE DENTAL AND SKELETAL
CHANGES PRODUCED BY THEM ARE ALMOST SIMILAR.CHANGES PRODUCED BY THEM ARE ALMOST SIMILAR.
HOWEVER THIS IS THE LAST ORTHOPAEDIC STEPHOWEVER THIS IS THE LAST ORTHOPAEDIC STEP
TOWARDS A HARMONIOUS FACIAL PROFILE USING THETOWARDS A HARMONIOUS FACIAL PROFILE USING THE
TERMINAL PHASE OF GROWTH.TERMINAL PHASE OF GROWTH.
CONCLUSION

74. REFERENCES :
1.COMBINED FIXED FUNCTIONAL CLASS II TREATMENT
JCO 1994 VAN DER SCHUREN , DE SMIT
2.CLINICAL APPLICATION OF THE MANDIBULAR
PROTRACTION APPLIANCE JCO 1995 MAY
CARLOS M COELHO FILHO
3.MPA 3 JCO 1998
4.MPA 4 JCO 2001 JAN CARLOS M COELHO FILHO
5CLINICAL USE OF CHIRRO JUMPER JCO 1998
RICHARD CASTANON ,MARIO S VALDES . LARRY W
WHITE