Pendulum Appliance: Long-Term Results

Correcting a Class II malocclusion is one of the most common challenges in orthodontics.

Among the available solutions, the Pendulum appliance is widely used to move upper molars backward (distalization) without relying on patient compliance.

But the real question is: are these results stable in the long term?

A clinical study followed patients for more than 7 years after treatment to evaluate exactly this point .

What Is the Pendulum Appliance

The Pendulum is an intraoral device used to:

• move upper molars backward
• correct Class II molar relationships
• reduce the need for external appliances or patient cooperation

It works through controlled forces applied inside the mouth, making it a non-compliance solution, meaning results do not depend on how well the patient follows instructions .

How the Treatment Works

The protocol analyzed in the study follows three main phases:

1. Distalization phase
   • molars are moved backward using the Pendulum
   • duration: about 8 months
2. Stabilization phase
   • a Nance appliance is used to maintain results
3. Fixed orthodontic treatment
   • braces align teeth and complete the correction

Patients were then monitored over time, with a final follow-up at around 22 years of age .

What Happens to the Molars Over Time

The study provides a very clear insight.

• molars are successfully moved backward during treatment
• part of this movement is naturally lost over time
• however, more than 50% of the distalization is maintained long-term

In numbers:

• about 5 mm distal movement during treatment
• about 2.2 mm relapse over time
• approximately 57% of the result remains stable

This is a key point:
the treatment effect is not temporary.

When Does Relapse Occur?

One of the most interesting findings is when relapse happens.

• most relapse occurs during the fixed appliance phase
• after treatment is completed, no significant changes occur

In other words:

• instability is not a long-term problem
• it is mainly related to the active treatment phase

Does the Bite Stay Correct Over Time?

Despite some degree of relapse, the study shows that:

the molar relationship remains stable.

There is no significant difference between:

• the end of distalization
• and the long-term follow-up

This means that the correction achieved (Class I relationship) is maintained during growth and adulthood .

Effects on Facial Structure

Another important aspect is facial balance.

During treatment:

• vertical facial dimension tends to increase
• this is linked to molar movement and extrusion

However:

• this effect is temporary
• facial proportions return to baseline after growth

So there are no long-term negative aesthetic consequences.

Why Growth Plays a Key Role

Orthodontic results are not static.
They interact with natural growth.

The study shows that:

• jaw growth continues after treatment
• teeth adapt through dentoalveolar compensation
• this helps maintain a stable occlusion over time

This is why treatment planning must always consider growth patterns.

What This Means for Patients

From a patient perspective, the conclusions are reassuring:

• the Pendulum appliance is effective
• results are largely stable over time
• long-term relapse is minimal
• final bite correction is maintained

However, success depends on:

• proper treatment planning
• correct use of retention strategies
• full orthodontic finishing with fixed appliances

Conclusion

The Pendulum appliance is a reliable solution for treating Class II malocclusion.

Clinical evidence shows that:

• molar distalization is effective and measurable
• more than half of the result is maintained long-term
• relapse occurs mainly during treatment, not after
• occlusion remains stable into adulthood
• temporary side effects, like vertical changes, resolve over time

In modern orthodontics, the goal is not just to move teeth, but to create results that remain stable throughout growth.

The Pendulum appliance, when used correctly, fits exactly into this philosophy.