The correction of interarch malocclusions using a

fixed force module

J. J. Jasper, DDSfl and James A. McNamara, Jr., DDS, PhD b
Santa Rosa, Calif., and Ann Arbor, Mich.
This article describes the use of a flexible force module (the Jasper Jumper) that can be
incorporated into existing fixed appliances to correct various types of sagittal malocclusion.
Essentially the spring mechanism described in this article is a modification of the original bite
jumping mechanism of Herbst. The flexible spring module provides greater freedom of mandibular
movement than is possible with the more rigid mechanism of the Herbst appliance. The facial
musculature applies force through these modules to the anchor points to produce a variety of
treatment effects. The treatment effects produced by the module mimic those previously described
for the Herbst appliance and include posterior movement of the maxillary buccal segments and
anterior movement of the mandible or mandibular dentition or both. Specifics of the clinical
management of this modular system are discussed, including anchorage preparation and torque
application, as well as the methods of anchoring, activating and reactivating the modules. (AM J
ORTHOD DENTOFACORTHOP 1995; 108:641-50.)

A
number of appliance systems, both fixed
and removable, have been advocated for the correction of malocclusions that are characterized by sagittal discrepancies between the dental arches and/or
their bony bases. The most frequently occurring sagittal malocclusion is the Class II type, for which a
wide variety of treatment modalities have been developed.
This article describes the basic components of
the jumper mechanism (Jasper Jumper), which can
be viewed as a modification of the Herbst bite
jumping mechanism? This interarch flexible force
module allows the patient greater freedom of mandibular movement than is possible with the original
bite jumping mechanism of Herbst.
EXTRAORAL VERSUS INTRAORAL APPLIANCES

Appliances traditionally used to treat Class 1I

malocclusion can be divided into two categories:
extraoral and intraoral. Typical extraoral appliances include face-bows that attach to tubes on the
upper first molar bands and headgears that attach
directly to the archwire or to auxiliaries connected
to the arch wire. 2-5
The typical extraoral traction device used in the
correction of Class II malocclusion applies forces to
~Private practice of orthodontics, Santa Rosa, Calif.
bProfessor of Dentistry, Department of Orthodontics and Pediatric Dentistry, School of Dentistry, and Research Scientist, Center for Human
Growth and Development, The University of Michigan; in private practice of orthodontics, Ann Arbor, Mich.
Copyright 1995 by the American Association of Orthodontists.
0889-5406/95/$5.00 + 0 8/1/59229

the maxillary dentition, either to retard forward

movement or growth of the teeth and maxilla and/or
to push the maxillary teeth posteriorly. Equally important is the associated vertical vector of force produced by these appliances. A high-pull face-bow
produces an intrusive force vector, whereas a cervical-pull face-bow tends to produce an extrusive
force vector. 6 The use of a cervical face-bow in a
patient with a short lower facial dimension may be
indicated, but this type of appliance often is contraindicated in patients with a normal to long lower
anterior facial height, due to the adverse vertical
forces produced (Fig. 1).
A wide variety of intraoral appliances also have
been advocated for the treatment of Class II malocclusions. These appliances can be categorized
into two groups: appliances that pull and appliances that push.
Appliances producing pulling forces

The most commonly used device that produces

pulling interarch force vectors is intermaxillary
elastics. Class II elastics are perhaps the most
commonly used means of changing the dentoalveolar (and skeletal) relationship in Class II malocclusion. Not only do Class II elastics produce sagittal
forces, but they also create extrusive forces (Fig. 2)
produced at the points of attachment (usually the
upper canines and lower first or second molars).
Such extrusive forces typically are indicated only in
those patients in whom an increase in lower anterior facial height is desired. McNamara 7 has shown
641

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American Journal of Orthodontics and Dentofacial Orthopedics

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:-.'.:.'!3:-.
.

Fig. 1. Diagrammatic view of forces produced by cervical-pull

face-bow. Note extrusive vector of force.

that only about 10% of patients with pretreatment

Class II mixed dentitions have decreased lower
facial height, whereas 30% to 50% have excessive
vertical development.
Another appliance system that produces a similar type of pulling force is the severable adjustable
intermaxillary force (SAW) spring developed by
Armstrong [personal communication] in 1957. In
contrast to intermaxillary elastics that are removed
and replaced by the patient, SAIF springs provide
a fixed pulling force. This mechanism has not been
used widely because of difficulties encountered in
appliance management, including breakage, hygiene, and comfort problems.

Appliances producing pushing forces

The second category of intraoral appliances
used in the correction of Class II malocclusion
includes those appliances that deliver a pushing
force vector, forcing the attachment points of the
appliance away from one another. This resultant
force contrasts with pulling devices, such as intermaxillary elastics, that brings their insertions closer
to one another.
Not included in this discussion are the vast
number of removable functional appliances that act
as active pushing (protrusive) appliances, in that
the use of these appliances typically results in a
change in the postural level of muscle activity and
will, in most instances, result in a change in mandibular posture, 8-~
Included in this discussion is one of the so-

Fig, 2. Vector of force produced by Class II intermaxillary

elastics. Although primary force is directed along occlusal
plane, extrusive forces are also produced.

called "fixed functional" appliances, which is the

Herbst appliance reintroduced by Pancherz 12-~4 after originally having been described by Herbst. 1
This type of pushing appliance is categorized as
r/g/d in that the Herbst bite jumping mechanism is
composed of two stainless steel "plunger" rod and
tube assemblies that usually are attached at the
upper first molar and lower first premolar regions.
This type of rigid pushing appliance produces vectors of force that are not only sagittal, but also have
been shown to be intrusive1416 (Fig. 3). In addition,
the forces tend to produce transverse expansion
and are more oriented along the downward and
forward direction of facial growth.
The treatment effects produced by the Herbst
bite jumping appliance (banded, cast or acrylic
splint design) have been well documented. The
studies of Pancherz, lz-15 Wieslander, 17 and McNamara and coworkers 16 have shown that both
skeletal and dentoalveolar effects are produced in
patients with Class II malocclusions who have worn
this appliance. In general, the treatment effects
produced are divided about equally between skeletal and dentoalveolar adaptations. The most common skeletal adaptation reported is an increase in
mandibular length (approximately 2.0 ram) in comparison to untreated Class II controls. ~4'16 Little
maxillary skeletal change has been noted. The most
pronounced dentoalveolar change has been a relative posterior movement of the upper buccal segment, with about 2.5 mm of distal maxillary first
molar movement noted in comparison to untreated

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controls. Forward movement of the lower molars

and proclination of the lower incisors also have
been reported. 14'16
One of the major advantages of the Herbst
appliance, and of any other fixed intermaxillary
appliance, is the relative speed at which treatment
effects are achieved. Traditional approaches to
treating a Class II malocclusion (e.g., extraoral
traction, Class II elastics) often are hampered by
problems with patient compliance. By anchoring
the device intraorally, the need for patient cooperation is reduced substantially.
One of the disadvantages of the Herbst appliance is the rigidity of the Herbst bite jumping
mechanism itself. Although every attempt is made
to allow freedom of movement by enlarging the
attachment holes of the tube and plunger to the
axles, the bite jumping mechanism restricts lateral
movements of the mandible.
In an attempt to overcome these problems,
Jasper 18 developed a new pushing device that is
flexible. This appliance produces both sagittal and
intrusive forces (Fig. 3), as does the Herbst bite
jumping mechanism, but affords the patient much
more freedom of mandibular movement. These
force modules also can be used in other applications and in other types of malocclusions, as will be
discussed later.
PARTS OF THE APPLIANCE

This modular system, know as the Jasper

Jumper, can be attached to most commonly used
fixed appliances. The system is composed of two
parts, the force module and the anchor units.
Force Module

The force module, analogous to the tube and

plunger parts of the Herbst bite jumping mechanism, is flexible (Fig. 4). The force module is constructed of a stainless steel coil or spring (see inset in
Fig. 4) that is attached at both ends to stainless steel
endcaps, in which holes have been drilled in the
flanges to accommodate the anchoring unit. This
module is surrounded by an opaque polyurethane
covering for hygiene and comfort. The modules are
available (American Orthodontics, Sheboygan,
Wis.) in seven lengths, ranging from 26 mm to 38 mm
in 2 mm increments. They are designed for use on
either side of the dental arch.
When the force module is straight, it remains
passive. As the teeth come into occlusion, the
spring of the force module is curved axially as the
muscles of mastication elevate the mandible, pro-

Jasper a n d M c N a r n a r a

643

.,,,j

Fig. 3. Pushing vectors of force produced by Herbst appliance and flexible force module. These bite jumping mechanisms guide mandible in forward position, producing protrusive and intrusive forces on lower arch and retrusive and
intrusive forces on upper arch.

ducing a range of forces from 1 to 16 ounces. This

kinetic energy then is captured when the force
module is curved, and the force is converted to
potential energy to be used for a variety of clinical
effects.
If properly installed to produce mandibular
advancement, the spring mechanism will be curved
or activated 4 mm relative to its resting length, thus
storing about 8 ounces (250 gin) of potential energy
for force delivery. If less force is desired (e.g., force
levels that produce tooth movement alone), the
jumper is not activated fully. Increasing the activation beyond 4 mm does not yield more force from
the module, but only builds excessive internal stress
in the module. The tendency to increase the force
for faster treatment results is to be avoided.
Anchor Units

A number of methods are available to anchor

the force modules to both the permanent and
mixed dentitions.
Attachment to the main arch wire. The most
common method of attachment of the force module
to the dental arches in patients in the permanent
dentition is through the use of previously placed
fixed orthodontic appliances. When the jumper
mechanism is used to correct a Class II malocclusion, the force module is attached posteriorly to the
maxillary arch by a ball pin that is placed through

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Fig 4 Attachment of distal end of force module to maxillary

dental arch through the use of ball pin. Appliance can be
activated by moving ball pin anteriorly. Alignment of spring
within jumper mechanism is shown in inset.

the distal attachment of the force module and then

extends anteriorly through the face-bow tube on
the upper first molar band (Fig. 4). The ball pin is
anchored in position by having the clinician place a
return bend in the ball pin at its mesial end.
Anteriorly, the module is anchored to the lower
arch wire. Bayonet bends are placed distal to the
mandibular canines and small Lexan beads are
slipped over the arch wire to provide an anterior
stop. The mandibular arch wire is threaded
through the hole in the anterior endcap and then
ligated in place. The removal of the brackets on the
lower second premolars in addition to the lower
first premolars (as advocated originally) allows the
patient greater freedom of movement.
Attachment to auxiliary arch wires. A n alternative
design incorporates the use of "outriggers ''19 (Fig.
5). This 0.016 x 0.022-inch (0.018-inch slot) or
0.018 x 0.025-inch (0.022-inch slot) auxiliary sectional wire allows the clinician to leave the premolar bonds or bands in place by attaching the force
module to a sectional wire that is anchored anteriorly to the main archwire between the first premolar and canine (Fig. 5, A). In addition, because
freedom for the modules to slide is increased, there
is a greater range of jaw movement. Repairs and
replacement of the jumper components are simplified with this outrigger modification.
The segmental arch wire is attached posteriorly
through an auxiliary tube located on the lower first
molar band (Fig. 5, A). The auxiliary wire can be
bent so that the vestibular section is parallel to the
occlusal plane (as shown in Fig. 5), or a shorter
vertical step can be placed posteriorly so that the

'

B
Fig. 5. Use of "outriggers" for anchoring force module. A,
Rectangular auxiliary arch wire is looped over main arch wire
anteriorly and is cinched back through auxiliary tube posteriorly. B, Ball pin is inserted through distal hole in jumper
modulo, is placed anteriorly through face-bow tube on upper
firstr molar band and is cinched forward to activate module.

inclination of the outrigger more closely approximates the downward and forward growth direction
of the patient's face. The posterior part of the
jumper module is attached to the ball pin placed
through the maxillary molar tube (Fig. 5, B), as
described previously.
If outriggers are used to anchor the module to
the mandibular dentition, care must be taken to
assure that the sectional arch wire provides adequate space between the alveolus and the gingiva
to allow the module to slide without tissue impingement. Contouring the sectional arch wire and placing first-order step-out bends in the arch wire may
be helpful. Once the module has been placed, the
module should slide smoothly along the sectional
outrigger wire.
Attachment in the mixed dentition. The force
module also can be used in patients with mixed
dentitions whose premolars have not yet erupted
(Fig. 6). The maxillary attachment is similar to that
previously described, in that the ball pin is used to
attach the force module to maxillary first molars.
The mandibular attachment of the force module is
through an arch wire that extends from the brack-

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Fig. 6. Use of force module in patient with mixed dentition. In

this instance, bayonet bend is placed distal to canine and
Lexan ball acts as stop for force module anteriorly. In this
example, upper and lower rectangular utility arches connect
anterior and posterior teeth.

ets on the lower incisors posteriorly to the first

permanent molars, bypassing the region of the
deciduous canines and molars (Fig. 6). In a patient
with a mixed dentition, the use of a transpalatal
arch and fixed lower lingual arch is mandatory so as
to control potential unfavorable side effects produced by the appliance (e.g., molar and incisor
tipping and flaring).
CLINICAL MANAGEMENT
Preparation of Anchorage

The most important aspect of the clinical management of this appliance system is the preparation
of lower anchorage and the control of mandibular
mesial tooth movement. As with the Herbst appliance, mesial movement of the lower incisors has
been reported with this appliance system.2'21 Unfavorable dentoalveolar adaptations can be minimized in the mandible through proper anchorage
preparation.
Alignment of the upper and lower anterior
teeth during the initial phases of orthodontic treatment must be completed. Full-sized (or nearly
full-sized) arch wires should be inserted into the
brackets in both arches before the placement of the
force modules. The arch wires should be tied or
cinched back posteriorly to increase anchorage
(Fig. 7), including second molars whenever possible. In addition, the clinician can place posterior
tip-back bends in the mandibular arch wire to
enhance anchorage.
When jumpers are anticipated in the treatment
plan, anterior lingual crown torque can be placed in
the arch wire. Alternatively, lower incisor brackets
with 5 of lingual crown torque incorporated into
the slot of the bracket also can be used to prepare

Jasper and McNamara

645

-I)
Fig. 7. Maximum anchorage setup for force module. Note
maxillary and mandibular arch wires extend to second molars
and are cinched back posteriorly. Tie backs also can be used.
Offset bend in main arch wire (see Fig. 8) is obscured by
Lexan ball.

anchorage. Lingually torqued lower incisor brackets are used in addition to, not as a substitute for,
anchorage in the mandible.
Use of Stabilization Wires

Two types of auxiliary arch wires can be used to

enhance anchorage: the transpalatal arch and the
lower lingual arch. A transpalatal arch (Fig. 8, A)
can be used in those instances in which distal
maxillary molar movement is to be minimized and
mandibular adaptations are to be maximized. A
transpalatal arch is not incorporated into the appliance system if maxillary dentoalveolar movement
is desired.
The use of a fixed lower lingual arch (Fig. 8, B)
is encouraged strongly in most instances. This type
of anchorage preparation is used routinely except
when significant lower incisor proclination is desired as part of the overall treatment plan (e.g.,
patients with mandibular dentoalveolar retrusion).
Preparation of the Arches

As noted previously, the jumper mechanisms

are not placed until the initial leveling and alignment of the dentition has been completed and
full-sized or nearly full-sized arch wires have been
placed in both arches. After the arch wires have
become passive, the mandibular arch wire is disengaged and the brackets on the first and second
premolars are removed bilaterally (Figs. 7 and 8).
Unless outriggers are used, bayonet bends are
placed in the arch wire distal to the lower canine
bracket, and 3 mm Lexan beads are slipped over
the ends of the arch wire and moved forward to

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z O

Fig. 9. Determination of proper length of force module.

Twelve millimeters are added to measurement of distance
between mesial aspect of face-bow tube and distal aspect of
Lexan ball. in this example, distance from ball to face-bow
tube is 20 ram. Thus 32 mm module should be selected.

8
Fig, 8. A, Use of transpalatal arch combined with fixed appliances to enhance maxillary anchorage. B, Use of lower lingual
arch in conjunction with fixed appliances to enhance mandibular anchorage.

rest against the bayonet bends bilaterally (Figs. 7

and 8).
Selection and Installation of the Modules

To determine the proper length of the module,

measure from the mesial of the upper molar tube
to the distal of the lower Lexan bead (Fig. 9).
Adding 12 mm to this measurement will give the
appropriate length for the module. The arch wire
then is threaded through the hole in the anterior
endcap of the force modules. The mandibular arch
wire is ligated in place, and the ends of the arch
wire are cinched or tied back firmly to prevent
proclination of the lower anterior teeth during
treatment. Thus, the force generated by the module
theoretically is distributed throughout the mandibular dentition. Then the ball pin is placed
through the distal hole in the force module and
inserted anteriorly into the face-bow tube on the
maxillary first molar band and cinched forward, as
described previously (Fig. 4).
In patients with high mandibular plane angles,

the pin is cinched to achieve approximately 2 mm

of module deflection (150 gm per side). In patients
with normal or low mandibular plane angles, the
ball pin is cinched forward to achieve 4 mm of
module deflection (300 gm of force per side). The
patient should be coached to practice opening and
closing movements slowly at first and told to avoid
excessive wide opening during eating and yawning.
The patient is cautioned to note any sticking of the
module and is taught how to move the module
forward with his or her fingers to "unlock" them.
The clinician must warn the patient against biting
on the jumpers or "popping" them as this will
result in breakage.
Activation of the Module for Orthodontic or
Orthopedic Effect or Both

The protocol advocated here is based primarily

on clinical experience. As previously described, the
jumper modules initially are selected and placed so
that the module assumes a mildly curved contour
when the patient is holding his or her jaw in a
comfortably retruded position. If molar distalization is desired, as can be accomplished in an adult
patient, a transpalatal arch will not be placed and
the maxillary arch wire will not be tied or cinched
back. The jumper is placed in this instance so that
only 2 to 4 ounces of force is produced by the
module (a measuring gauge can be used to determine the precise amount of activation). In a growing patient in whom an orthopedic repositioning of
the mandible is desired, higher force levels (e.g., 6
to 8 ounces) are used continuously.

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Jasper and McNamara

647

Reactivation of the Module

If the Class II molar relationship is not corrected completely by the initial activation of the
appliance, the modules should be reactivated 2 to 3
months after initial placement. The modular system
is activated most easily by shortening the attachment to the maxillary first molar bands. The pin
extending through the face-bow tube is pulled anteriorly 1 to 2 mm on each side to reactivate the
module (patients with higher mandibular plane
angles are activated 1 mm per side). One should
avoid shortening the ball pin excessively so that the
jumper will not bind against the distal aspect of the
face-bow tube and prevent its rotation. Two to four
millimeters of the pin should extend distally when
the pin is activated maximally.
Activation of the force module also can be made
through adjustments in the lower arch. Crimpable
stops (e.g., 1 mm, 2 mm) placed mesial to the Lexan
ball can be used to produce a precise, controlled
activation of the modules. Activation of the appliance in this manner is more accurate and easier to
perform. It also avoids unintentional restriction of
the ball pin/molar tube relationship as well as the
necessity to replace the module with a larger size.
At each appointment, the clinician should
check to be certain that none of the anchoring
bands or tiebacks have become loosened. In addition, the distal extensions of the ball pin often must
be restraightened so that it is parallel with the
occlusal plane. If outriggers are used, the anterior
portion must be adjusted so as not to contact the
distal of the lower canine bracket. Observance of
increasing interdental spacing in the anterior segment indicates a breakdown of appliance integrity.
TYPES OF FORCES PRODUCED

Directions of force generated by the modules

bilaterally include sagittal as well as intrusive and
expansive forces. The sagittal forces will distalize
the posterior anchor unit (e.g., maxillary first molars or maxillary first and second molars) and also
will apply an anterior force to the mandible and
mandibular dentition (Fig. 3). In addition, an intrusive force is produced in the maxillary posterior
region as well as the mandibular anterior region.
A buccal force also is produced by the module
(Fig. 10). An intrusive force applied along the
buccal surface of a tooth will produce maxillary
arch expansion, a treatment response typically observed using the jumper mechanism in combination
with fixed appliances. In addition, the modules

Fig, 10. Expansive forces are positive side effect produced by

intrusive forces of jumper mechanism.

curve toward the buccal, producing a modest vestibular shielding effect (Fig. 11).
Expansive forces can be minimized or eliminated through the use of a transpalatal arch (Fig.
8, A) and/or a heavy arch wire that has been
narrowed and to which buccal root torque has been
applied. Indeed, clinicians are encouraged to add
buccal root torque if arch expansion, not molar
tipping, is desired. The expansive forces produced
by the module can be contrasted to the lingual
crown torque that is produced by extrusive pulling
mechanics (e.g., Class II elastics).
TREATMENT EFFECTS

After the dental arches has been prepared

properly, the modules can be used to produce
numerous treatment effects.
Maxillary Adaptations

Headgear effect. One of the treatment effects

produced most easily by the force modules is the
distalization of the upper posterior segment (i.e.,
the headgear effect). This type of movement is
achieved by not cinching or tying back the maxillary
arch wire but rather by allowing the arch wire to
remain straight and slightly extended past the buccal tubes. Light forces (e.g., 2 to 4 ounces) then can
be expressed by the modules to distalize the upper
molars. Because the forces are resisted by the
entire lower dentition, minimal changes in mandibular dentition are noted. The headgear effect
can be produced not only in actively growing patients, but also in some adult patients in whom
maxillary molar distalization is desired. 22 There is
no evidence to support the hypothesis that this type
of appliance can be used to promote mandibular
growth in adult patients.
Once the desired distal movement has been
achieved, the module can be left in place to support
the retraction of the premolars and canines. Segmental or continuous arch mechanics can be used
to retract these teeth while maintaining molar an-

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Fig. 11. Force module curves to buccal, producing shielding

effect on dentition. Offset bends in main arch wire are not
observable in this view.

chorage. Alternatively, the force module can be left

in place to support the molars while the premolar
and canine teeth spontaneously move posteriorly as
a result of the pull of the gingival transseptal fibers
between the teeth (the so-called "driftodontic effect"). A transpalatal arch or Nance holding arch
also may be used to maintain the correction.
Retraction of anterior teeth. Canines can be retracted in both extraction and nonextraction patients with the posterior maxillary dentition supported by the force module (Fig. 12,A). In addition,
a NiTi coil or an intramaxillary elastic attached to
the pin through the face-bow tube can be used to
retract upper canines or the six anterior teeth en
masse. The pull on the pin is resisted by the modules
and the mandibular dentition (Fig. 12, B).
Dental asymmetries. The force module system
also can be used in patients who have sagittal
dental asymmetries. In a Class II subdivision-type
patient, the maxillary arch wire can be tied back on
the side of the existing Class I molar relationship.
Asymmetrical orthopedic effects may be developed
as well.
Mandibular Adaptations

As stated previously, every effort should be

made to incorporate maximum anchorage techniques when preparing the mandibular arch for this
appliance (Fig. 7). In growing patients, changes in
mandibular position and presumably changes in
mandibular length are achieved after force module
application. To date, no major prospective research
evaluating the effectiveness of the appliance has
been conducted. However, it may be assumed that
the treatment effects produced by this flexible force
module are similar to those of the Herbst appliance, due to the similarities in their mechanisms of
action (Fig. 3).

Fig. 12. Retraction of upper canine with ball pin and force
module. NiTi spring or elastomeric chain can be attached from
ball pin anteriorly to either (A) canine bracket or (B) maxillary
arch wire. In this manner, anterior retraction is anchored
posteriorly by forces generated against mandibular dentition
rather than maxillary dentition.

When attempting to produce mandibular advancement, the major variation in clinical management is the preparation of the maxillary anchor
unit. To maximize mandibular change, the movement of the maxillary posterior dentition must be
minimized. The arch wire should be cinched or tied
back, as is accomplished routinely in the mandibular dentition. In addition, a transpalatal arch (Fig.
8, A) should be used to obtain intraarch anchorage
and minimize posterior tooth movement. A fixed
lower lingual arch also is recommended.
As previously discussed, when mandibular advancement is desired, generally the level of force
generated by the module is greater (i.e., 6 to 8
ounces) than that when maxillary molar distilization is intended (2 to 4 ounces). By maximizing the
force values produced by the module, patients tend
to posture their jaw in a forward position. In
contrast to the Herbst bite jumping mechanism,
however, the spring mechanism allows more freedom in both sagittal and lateral movements.
ADDITIONAL APPLICATIONS

This article thus far has considered the use of

the jumper mechanism primarily in the treatment
of Class II malocclusion, the typical application of
this type of appliance. This system of modules also
has been used to support anchorage for the retraction of maxillary anterior teeth (described previously) in patients with Class I malocclusions.

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Jumper modules also can be used in the patient

with Class III malocclusion. In contrast to the rigid
bite jumping mechanism of the Herbst appliance,
the flexibility of the jumper mechanism allows its
use in patients with Class III malocclusions. It is
recommended that this appliance be used in patients who are characterized by maxillary skeletal
retrusion rather than mandibular prognathism.
When using this system in a patient with Class
III malocclusion, the mandibular anchor points are
mesial to the permanent first molars. Bands that
have auxiliary headgear tubes or lip bumper tubes
are used to anchor the ball pin of the distal endcap
of the force module. Anteriorly, the Lexan ball is
placed distal to a bayonet bend just behind the
bracket on the upper canine (or at an appropriate
place on the upper arch wire if the canines are not
yet erupted). This appliance in patients with Class
III malocclusions can be used in conjunction with
rapid maxillary expansion. Forces generated when
the modules are used in this manner usually are
light (e.g., 2 to 4 gin). This type of treatment should
be discontinued immediately if any signs or symptoms of temporomandibular disorders develop.
Other potential applications may include the
correction of anterior crossbites in patients with
functional (pseudo) Class III malocclusions, the
postsurgical stabilization of patients with Class II
or Class III malocclusions, and presurgical muscle
conditioning of patients with Class II malocclusions.
DISCUSSION

This article has considered a flexible type of

bite jumping mechanism that pushes against the
maxillary and mandibular dentitions. This module
is a modification of the bite jumping mechanism of
Herbst that was developed nearly 100 years ago. 1
The well-documented treatment effects of the
Herbst bite jumping mechanism appear similar to
those produced by the force module described in
this article. Both systems produce a relatively rapid
correction of a Class II malocclusion by producing
both sagittal and intrusive forces. Both skeletal and
dentoalveolar adaptations have been observed with
the jumper mechanism. 2'2~
This flexible force module system differs from
the Herbst bite jumping mechanism in a number of
significant areas. First, the amount of force applied
by the modules is more easily controlled by the
clinician. The flexibility of the force module has
been shown to increase patient comfort because
greater lateral and sagittal movements are possible.
In addition, the force module curves away from the
dental arches in its activated position, thus making

Jasper and McNamara

649

mastication and oral hygiene procedures easier to

perform than with the Herbst appliance.
Another advantage of this auxiliary appliance
system is that it can be added to existing appliances
virtually at any point after arch preparation. The
modules can be used as a primary method of
treatment or can be added at a later time after
alternative treatments (e.g., extraoral traction,
functional jaw orthopedics) have proven unsuccessful. There is no need to remove the entire fixed
appliance setup before the force modules are
placed, nor is there additional laboratory cost or
lost time during treatment if the fabrication of
lower lingual or transpalatal arches is not required.
As with any fixed force system, there are disadvantages associated with the use of these modules.
The two most significant disadvantages are breakage and unwanted tooth movement. The fact that
these modules often are used on "uncooperative"
patients increases the concern of breakage.
The appliance system has been improved over
the last 10 years, so that now the modules are more
resistant to fracture during appliance wear. Patients should be instructed not to chew on the
appliance and also not to perform wide open movements. Strict dietary controls are mandatory. In
addition, the patient should be cautioned repeatedly not to "pop" the modules after yawning or
excessive wide opening.
As mentioned earlier, it is critical that the
clinician must prepare anchorage before the force
module is placed against the lower arch. If the arch
wire is full sized (or nearly so) and is properly
anchored posteriorly, forward movement of the
lower dentition is minimized. The placement of
lingual crown torque anteriorly and tip-back bends
posteriorly will further enhance anchorage. If the
clinician is concerned about the mesial movement
of the lower dentition, use of lighter forces with the
module is advocated.
As is usual with the incorporation of a new
technique or appliance into an established regimen,
clinical experience is necessary before the practitioner becomes comfortable with the manipulation
and handling of the new adjunct. Thus, initial case
selection is important for first-time users of the
appliance. For example, a seeminly cooperative
patient presenting with mild Class II diagnostic
features and minimal anchorage requirements is
ideal. The treatment of noncooperative patients,
"bail-out" patients, or patients who have severe
skeletal Class II problems should be left to practitioners who have considerable experience in manipulation of the modules.
If used appropriately, this appliance system pro-

650

Jasper and MeNamara

vides the opportunity of minimizing patient coope r a t i o n in t h e c o r r e c t i o n o f s a g i t t a l d i s c r e p a n c i e s . I f

p r o p e r a n c h o r a g e p r e p a r a t i o n is a c h i e v e d a n d
f o r c e v a l u e s a r e k e p t w i t h i n p h y s i o l o g i c limits,
successful treatment outcomes can be attained.
The illustrations for this manuscript were provided
by Mr. William L. Brudon. W e thank him for his excellent art work. We also acknowledge the technical contributions of Drs. Lee Graber, William Machata, Mart
McClellan and Joyce Chang to this manuscript.
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American Journal of Orthodontics and Dentofacial Orthopedics

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Reprint requests to:

Dr. James. A. McNamara
Department of Orthodontics and Pediatric Dentistry
School of Dentistry
The University of Michigan
Ann Arbor, MI 48109-i078