The pendulum appliance uses acrylic and springs to deliver continuous force from the palate to the upper molars, producing distal movement without affecting other teeth. It is fabricated with acrylic covering springs that extend to molar bands. Springs are activated in 3-week intervals to monitor distalization over 4 months before stabilizing molars. The appliance effectively treats Class II malocclusions without extractions through distal molar movement.

1. Pendulum appliance
Done by : Dr. Salaheddin Dahbour
Supervised by :
Dr. Ahmed Al-Tarawneh
Dr. Jumanah Tbaishat
Dr. Anwar Al-Rahamneh

2. Introduction
• James J Hilgers of California introduced the Pendulum Appliance in
1992 as a mechanism for Class II non-complaince treatment .
• The Pendulum Appliance uses a large Nance acrylic button for palatal
anchorage and 0.032” TMA springs to deliver a light, continuous force
to the upper first molars without affecting the palatal button.
• The appliance produces a broad pendulum of force from the mid
palate to the upper molars.

3. Fabrication
• The right and left Pendulum springs, formed from 0.032” TMA wire,
consist of a molar insertion wire, a small horizontal adjustment loop, a
closed helix and a loop for retention in the acrylic button.
• The springs are extended close to the center of the palatal button to
maximize their range of motion, allow easier insertion into the lingual
sheaths and reduce forces to an acceptable range. Tongue irritation
during swallowing is minimized by extending the springs distal to the
button.
• The plane of the coil springs should be parallel to the maxillary plane

4. Dimensions of average
pendulum spring in mm
(actual span depends on
palatal width).

5. Fabrication
• The anterior portion of the appliance is retained in place with occlusally
bonded rests on the first and/or second bicuspids.
• In case, the second bicuspids are bonded then these rests can be removed
later in treatment to allow the second bicuspid to drift distally.
• 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

6. Pendulum appliance at start of treatment

7. Preactivation and placement
• The molar bands are cemented without the springs engaged. Once
the appliance is in place, Pendulum springs are seated in the lingual
sheath with the help of Weingart pliers.

8. weingart plier

9. Pendulum appliance after
distalisation of molars

10. Reactivation and stabilization
• The patient should be seen every three weeks to monitor the spring
pressure. The spring may be reactivated to the desired extent, if needed.
• molar(s) should be distalized into an over corrected Class I relation (if one
is correcting a Class II). This can take up to 4 months.
• Once the molars have been moved distally ,they are stabilized in their
new position.
• It is imperative to move the buccal segments into a Class I relationship to
harness the full advantage of the appliance. The upper molar bands are
utilized to place a trans palatal bar or Nance appliance immediately after
removal of the pendulum.

11. The molars can be stabilized in any of the
following ways:
• The same day the P.A. is removed a Nance arch 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. It is also recommended that the Nance
arch be soldered to the upper molar bands.
• After 3 - 4 months, fixed appliances are used as the last step in
treatment.

13. 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 an
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..
• Initial activation should not exceed 250 grams with the arms bent
backat about 45° (already prepared by the lab-technician)

15. • Up righting is accomplished using an „up righting bend“ of 10° to
15°which is introduced intraorally with a weingart plier.
• 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.
• 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.

17. Maxillary arch after retraction of cuspids

18. 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.

19. • 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, distalize the
first molar with the P.A. and then let the third molar erupt into the
space left by the extracted second molar.

20. Diagnostic criteria
• Since the Pendulum appliance drives the upper molars distally (with slight
lingual tipping) quite rapidly, there is a tendency for the anterior bite to
open.
• This open bite generally corrects itself in brachyfacial patients, but it can be
a problem in dolichol-facial types, especially those with tongue-thrust
habits.
• It is still recommended to treat vertical growth patterns conservatively with
extractions, directional headgears and transpalatal bars.
• The bite-opening tendency can be encouraged in brachyfacial patients by
bonding the Nance portion of the appliance to the occlusal surfaces of the
bicuspids or deciduous molars.

21. Diagnostic criteria
• Distal movement of the molars appear to be most efficient before the
upper second molars have erupted.
• Unilateral Class II patients also benefit greatly from Pendulum
therapy.
• There are some cases where forward positioning of one molar due to
early loss of deciduous teeth and mesial drifting of the molar is the
root cause of the malocclusion.
• A Pendulum spring on one side can regain space without putting
undue strain on other parts of the upper arch.

22. Diagnostic criteria
• A fixed rapid palatal expander with incorporated Pendulum appliance
can accomplish dual purpose of rapid maxillary expansion and molar
distalisation (pendex).

23. Limitations of Pendulum Appliance
• (a) Torquing or rotation of molars : If the helix loop is not adjusted
correctly, the pendulum spring can be distorted and can result in
undesirable rotation or torquing of the molars

24. • b) Tissue Irritation:
1. Food and plaque accumulation under the palatal acrylic cause
slight tissue inflammation. This does not limit the use of this
appliance.
2. The activated helix loop of the Pendulum springs cause anterior
reciprocal forces to be generated against the palatal acrylic and
the palate. With a larger palatal acrylic, the generated forces are
spread over a wider area with minimal palatal irritation.

25. biomechanics

26. biomechanics

27. biomechanics

28. Patient instruction

30. Modifications

31. pendex

32. T-rex

33. Pendulum B

34. To sum up
• The pendulum is used in uncompliant patients to distalize upper first
molars mainly in class II cases with cusp to cusp relationship with an
acceptable facial profile.
• Band selection and fitting is a really important aspect to think about
when fabricating the appliance.
• Best time to use the pendulum appliance is when the second molars
haven’t erupted yet and the prognosis if the other teeth is good .
• Pre-activation is better than intraoral activation.

35. • The patient should be reviewed every 3-4 weeks, always check for
molar relationship, over jet, the vertical dimensions and cross bite on
the molar being distalized.
• Reactivation is only done after 3 months.
• Planning anchorage when retracting the other teeth is the key of
successful treatment.

36. Conclusion
• Patient tolerance of the Pendulum appliance is excellent.
• It is a very efficient technique to correct Class II malocclusion without
resorting to extractions and with minimal patient compliance.
• It is simple and easy to fabricate, with minimal laboratory support.
• The cost of a Pendulum appliance is a fraction of the cost of
commercially available molar distalization appliances.

37. References
• Hilgers JJ.: The Pendulum Appliance for Class II non-compliance therapy.J.Clin.
Orthod. 1992; 16:706-14.
• Effects of the Pendulum Appliance on the Dentofacial ComplexJose Chaques-Asensi, Varum Klara
J. Clin. Orthd. 35: 254-257, 2001
• Bonded Pendulum ApplianceSurg Lt Cdr SS Chopra*, Surg Cdr SS Pandey Received : 20.03.2004; Accepted :
09.09.2004
• https://pixabay.com/en/photos/?q=orthodotic&hp=&image_type=all&order=&cat=&min_width=&min_height=
• http://studyres.com/doc/1687712/the-pendulum-appliance-indications-and-clinical?page=3
• https://www.youtube.com/watch?v=YPZXvHFtRE8&feature=youtu.be

38. Thank you