Clinical Practice Angle Pearls Iino Distalizer: A Modified Pendulum Appliance Our practice has made modifications to the traditional pendulum appliance and developed an alternative molar distalization appliance called the Iino (pronounced " eeno " ) distalizer. The appliance was named after our lab technician, who had been on our team for almost 30 years. The Iino distalizer may be fabricated with an expansion screw (similar to a Pend-X) or without (Figure 1). Dr. Paul M. Kasrovi Berkeley, CA PCSO Bulletin Contributor The Iino distalizer is similar to the pendulum appliance in that it attempts to maintain the positive effects of the pendulum appliance while perhaps minimizing its most adverse side effects: palatal irritation and/or inflammation. Because the pendulum appliance is permanently bonded or cemented to the first premolars, there is lack of access to the palatal tissue, which inhibits the maintenance of adequate oral hygiene throughout the course of treatment. To reduce concerns about oral hygiene, the Iino distalizer is not bonded to the premolars but is instead secured to the first premolars using Adams clasps (Figure 2). The advantage of this modification is that the patient is able to tip down the anterior portion of the appliance to expose the palatal tissues and the tissue side of the acrylic for cleaning (Figure 3). The Iino distalizer is a hybrid appliance; it can be displaced from the Figure 1. The Iino distalizer without and with an expansion screw Figure 2. Comparison of a pendulum appliance (left) and an Iino distalizer (right) Winter 2022 PCSO Bulletin 43