From the early 20th century, the treatment of Class II malocclusion was developed in Europe, notably with Robin’s monobloc, the Frankel functional regulator, the Balters bionator and later the Herbst appliance. A common feature of these appliances is mandibular advancement, which induces both muscular and functional changes. The effectiveness of such appliances remains debated; however, as the French orthodontist Julien Philippe aptly stated: “These appliances correct Class II.”1 Since these are removable devices, their outcomes are highly dependent on patient compliance.
Figs. 1c & d
The aim of this clinical study is to present a Herbst-type mandibular advancement device that was developed and patented by Dr Wajeeh Khan. This device—the orthocaps Rainmaker—is used in conjunction with aligners and thus offers new therapeutic possibilities for both Class II correction and sleep-related breathing disorders. We were able to test this appliance clinically and introduce minor adaptations in routine practice.
Description of the orthocaps Rainmaker appliance
The orthocaps Rainmaker was developed in 2017 for the treatment of Class II cases while orthodontic tooth movements are carried out through aligner therapy. The appliance’s construction enables removal of the active components at the end of a wear interval and their attachment to the subsequent aligner set, allowing continuous use throughout the entire treatment period.
The orthocaps Rainmaker consists of:
- four pivots with spherical heads;
- two tubes with ball sockets that clip on to the pivots on the maxillary aligners; and
- two rods with ball sockets that clip on to the pivots on the mandibular aligners (Figs. 1a–d).
The orthocaps Rainmaker combines the advantages of functional mandibular advancement appliances with the flexibility of contemporary aligner therapy. Its modular design and compatibility with digital planning systems make it an innovative and patient-friendly therapeutic option. Clinical use of the orthocaps Rainmaker has demonstrated rapid patient adaptation and easy integration into daily life (Figs. 2a–c).
Fig. 3
Fabrication requirements
Fabrication requires a lateral cephalogram. In CAD software, the radiograph is used to determine the hinge axis, which serves as a virtual centre of rotation for simulating the required mandibular opening and vertical clearance for the orthocaps Rainmaker design. The anatomical landmarks visible on the radiograph that determine the condylar path angle during opening and closing are also used, enabling precise reproduction of jaw movement and mandibular advancement without patient discomfort.
Wear protocol
The first appointment is dedicated to delivery of the appliance without attachments. At the second appointment, attachments are placed and wear habits assessed. Recommended wear is daily at home from the end of the schoolday and overnight (Figs. 4a–d).
Table 1: Cephalometric data before and after treatment.
Rainmaker as an anti‑snoring appliance
Obstructive sleep apnoea results from relaxation of pharyngeal soft tissue during sleep, leading to airway narrowing or obstruction. Maintaining the mandible in a protrusive position is a well-established therapeutic approach that helps maintain airway patency. The orthocaps Rainmaker is particularly suitable for this purpose. Additional aligners can be manufactured and provided to the patient, allowing periodic replacement throughout treatment to help maintain hygiene.
Clinical case
The orthocaps Rainmaker was used in a case of severe Class II, Division 1 malocclusion (Figs. 5a–8b). The child’s medical history included recurrent ear, nose and throat infections and a pollen allergy.
Although the initial precision fit provided good retention, this decreased over time. The addition of attachments significantly improved retention. At the six‑week follow-up, mild material fatigue and early wear were observed. After about two months, fractures occurred at the connection between the aligners and telescopic rods, leading to reinforcement modifications in the attachment regions.
Conclusion
Our clinical experience indicates that successful use of the orthocaps Rainmaker results not only in Class II correction but also in improved breathing. Mandibular advancement enlarges the nasopharyngeal airway and improves upper airway patency. The appliance is compact and comfortable and allows stepwise activation, supporting patient compliance and stable treatment outcomes.
